Medicare For Dentists

Thursday Troubleshooter: Practice accepts Blue Cross; does it still need to opt into Medicare?

Dec. 11, 2014
Questions abound regarding dental offices and opting in our opting out of Medicare. Does this office need to opt in if they accept
Medicare Plus Blue and BCN Advantage?

QUESTION: I am a dental office manager, and our office sees patients who are enrolled in Medicare Plus Blue and BCN Advantage for dental. Since we are a provider for this program, does that include us as Medicare providers or do we need to enroll? If we were to opt out of enrolling, would that mean we could no longer participate with Medicare Plus Blue and BCN Advantage through Blue Cross? Thank you for whatever advice you may offer.

ANSWER FROM DR. LOUIS MALCMACHER, President, American Academy of Facial Esthetics, [email protected]:
I will refer you to my five-part series on Medicare and dentistry in my Dental Economics column for some of the issues that you bring up. (Visit and search for Malcmacher.)

To address your questions, I went to the Medicare specialists with your question, which really has two parts. The first answer is – the Medicare that your office needs to make a choice about is Medicare Part B. This has nothing to do with the any of the dental plans associated with Medicare Advantage. Even if you are already a provider for a Medicare Advantage dental plan, you still need to either opt-in or opt-out for Medicare Part B.

The second part of your question is – if you opt out of Medicare Part B, does that opt out apply to Medicare Advantage dental plans? Probably not. The reason my answer is somewhat vague is because this is new, even to Medicare. The STATDDS experts have found that for those few dentists who have opted out, it has not changed their relationship with the Advantage dental plans.

Assuming you are a general dental office, my question to you is, why would you want to opt-out? Please read my article on Medicare Opt-Out in the November DE. Opting out requires the most continual paperwork and oversight. The Medicare experts report that 99% of dentists have chosen to opt-in for ordering instead of opting out. STATDDS submitted the applications for my own dental offices when we chose this option. I tried doing it myself but the application is very tedious, so I went with professionals and I recommend every dentist to do the same.

founder and president of Links2Success:
I would still have the office enroll, and these patients should be informed of all services that are covered and not covered. If you opt out of regular Medicare, you will have to have all Medicare patients sign a special form (page 12 of PDF). At this point, I would make sure your doctor’s NPI is listed for RX, biopsy. If you’re on one of the plans that are additional to Medicare (see photo below), you have to be in network and not all services are covered.

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