Updates to Medicare Opt In/Opt Out Process and Medicare Advantage Plans

Krysia Gabenski Featured News

May 19, 2015

In the winter 2015 Journal of the Colorado Dental Association, the CDA published detailed information about the requirement for dentists to either enroll in or opt out of Medicare before June 1, 2015. Since then, the Centers for Medicare and Medicaid Services (CMS) has made some updates in regard to the opt-in/opt-out deadlines and in regard to patients who use Medicare Advantage plans.

The official date to opt in or opt out remains June 1, 2015, but the CMS will not enforce this requirement until Jan. 1, 2016, essentially giving providers a seven-month grace period. It’s important to note that it takes at least 90 days to process the application, so be sure to file your application before Oct. 1, 2015.

As explained in CDA’s winter 2015 journal article, even though most common dental procedures are not covered under Medicare, dentists are still required to opt-in or opt-out of Medicare as a result of federal healthcare reform laws. By opting-in or opting-out of Medicare, you will help ensure tests, procedures, devices and drugs ordered for Medicare patients will be reimbursed, as well as prevent denial of reimbursement for other providers to whom you might refer Medicare patients.

For dentists who choose to opt out of Medicare, it’s important to note you no longer will be able to bill patients who receive dental care through Medicare Advantage plans. Medicare Advantage plans are the supplemental coverage plans typically offered through private insurers such as Aetna, Anthem, or Humana. These plans may provide extra coverage for services not routinely offered under Medicare, including dental. If you treat patients who have dental coverage through Medicare Advantage plans and intend to continue billing these patients for services, you will need to consider opting in as a full Medicare provider or the limited option of opting in as an ordering and referring provider.

To learn more about these options, click here to read the article “Medicare Enrollment Opt-in or Opt-out.”