What a wonderful meeting the Business of Dentistry was.  I was on an amazing panel for insurance billing, with Teresa Duncan and Lois Banta and this question was asked.  I hope everyone reads so they can choose the action they need for their office.

 

The Medicare deadline for Delta Dental and other dental insurance companies is rapidly approaching: January 1, 2017. Are you prepared

With the January 2017 Medicare deadline looming for Delta Dental and other dental insurance companies, it is time for you to take immediate action and choose what you are going to do when it comes to Medicare Part B.

Federal regulations require dentists to take action by either opting in to enroll or opting out of Medicare Part B so that their Medicare patients aged 65 and older will be eligible to receive Medicare Part D benefits, including prescriptions and referral testing, from their Medicare-enrolled provider. (That's you.) Enrollment also determines whether these patients can be seen in your office for dental benefits covered under their Medicare Advantage plans.

This requirement begins January 1, 2017. Until very recently, this requirement was scheduled to begin February 1, 2017, but many dental insurance companies, including Delta Dental, amended their contracts midyear in 2016. What this means is that you need to submit an application ASAP. It takes a few months for Medicare applications to be processed, so you will appear on the Medicare Ordering and Referring Registry in order for your practice to be able to protect and keep all of your Medicare Advantage patients from every insurer and be able to stay in-network.  

Some dentists have mistakenly decided to ignore this until the last possible minute, hoping it will go away. Others have had a knee-jerk reaction to opt out of Medicare Part B. Early on, there were even some dental societies and organizations advising dentists to opt out without thinking through some of the implications. Those dentists are now going to lose patients based on this poor decision.

Medicare Advantage plans, also known as Medicare Part C, are Medicare plans administered by insurance companies, such as Delta Dental, Blue Cross Blue Shield, Humana, Providence, Aetna, Cigna, and most of the other big insurers. These plans offer additional benefits to Medicare patients, including vision and dental coverage. So many dentists are shocked to find out that they already accept these plans in their offices.

According to the ADA Morning Huddle, 31% of the approximately 50 million Medicare enrollees are on Medicare Advantage plans, and that figure is going to increase significantly in the future.1 We are talking about tens of millions of highly desirable geriatric patients who are the wealthiest demographic in history, who are living long lives, and who are patients spending on dental care—especially implants, esthetic dentistry, and facial esthetics. The question you now need to ask yourself is: Do you want these patients in your practice?

Now you must make a decision about Medicare Part B. Delta Dental of Michigan, Ohio, and Indiana—one of the biggest—made an announcement about amending network contracts to mandate that dental professionals take action regarding Medicare Part B in order to stay in-network, effective January 1, 2017. Other insurers will follow. Delta Dental, along with most other insurers listed above, have now made your Medicare Part B choice very simple: Dentists who choose the opt-out Medicare Part B option will no longer be eligible to be in the Delta Dental network and will lose these patients.2

your patients who are covered by Delta Dental, Blue Cross Blue Shield, Humana, Providence, Aetna, Cigna, etc CAN ALSO BE LOST? If you want to keep these patients, you need to enroll in Medicare Part B quickly. If you want to lose these patients, you should opt out. If you do opt out, know that you will be locked out from Medicare Advantage patients for two years. These patients won't be returning to your office once they have found other providers.

Medicare enrollment specialists for their most recent statistics about the thousands of dentists they have advised and prepared Medicare applications for. Of their dental clients, 98.5% have chosen the opt-in option, which ensures that they will keep their Medicare Advantage Delta Dental patients, as well as any others whose insurers amend their network contracts. Of the remaining clients Links2Success has advised, 1% opted out of Medicare and all Medicare Advantage plans from every insurer, and 0.5% opted in for billing, which applies to very few dentists.

References

  1. ADA Morning Huddle. Published July 12, 2016.
    2. Soderlund K. Regional Delta Dental office amends dentists' contracts to address Medicare. ADA News. Published August 15, 2016.

Christine Taxin
Links2Success
36 Abington Avenue
Ardsley, New York 10502
United States of America