Opting out of Medicare results in dentists, patients not being reimbursed by Medicare Advantage

A March letter from a Medicare Advantage plan sent to dentists in New York has prompted many questions to the ADA on the Medicare opt-out process.

The ADA Council on Dental Benefit Programs is reminding dentists that if they opt out of Medicare, then neither they nor their patients can get reimbursed by a Medicare Advantage plan, also known as a Medicare Part C plan. There is an exception for emergency or urgently needed services.

The letter from Excellus, an independent licensee of the BlueCross BlueShield Association, dated March 25 stated that if dentists opt out of Medicare, Excellus cannot reimburse their practices for services they render to Medicare Advantage members.

A Medicare Advantage plan is a health insurance plan that provides Medicare benefits through a private-sector health insurer and may include benefits such as dental, vision and chiropractic.

Dentists can determine if they have opted out and when they can terminate their opt-out status at CMS.gov.

Opt-out affidavits signed on or after June 16, 2015, automatically renew every two years. If a dentist filed a valid affidavit effective on or after June 16, 2015, and does not want the opt-out to automatically renew at the end of a two-year opt-out period, the dentist may cancel the renewal by notifying in writing all Medicare administrative contractors with which the dentist filed an affidavit at least 30 days prior to the start of the next opt-out period.

A dentist who opts out of Medicare for the first time may terminate the opt-out by notifying all Medicare administrative contractors with which the dentist filed an opt-out affidavit within 90 days of filing the affidavit.

The ADA supports members by providing valuable resources and FAQs on Medicare and Medicare Advantage plans.

For additional educational, ready-to-use information on dental insurance, visit ADA.org/dentalinsurance.