04 Apr Opting IN or OUT of Medicare?

By June 1st you must make a decision. The details either way are in my opinion “gray”, but what government program doesn’t have ambiguous details? We do know Medicare actually does not reimburse for most dental procedures and of those few procedures they do cover they are typically reimbursed at a fraction of the UCR fee.

If you choose to option out then you are out for two years and will have to go through the opting out exercise every two years. The real challenge for practices OUT of the Medicare network is that they will be required to inform all of their patients enrolled in Medicare that they are not a contracted provider with Medicare. This is taken a step further, Medicare patients will be required to sign a contract acknowledging release of any Medicare support prior to being seen. It is my understanding that opting out may also jeopardize the provider’s ability to bill a supplementary insurance like AARP or Med Advantage.

Additionally, if you opt OUT, your Medicare patients will not be able to utilize their Medicare Part D prescription benefits for medications you prescribe for them.

Although opting out seems to be the most popular decision initially, before you do I would encourage you to consider the time and communication which will be needed to preserve this patient base and the real possibility of the loss of supplemental billing.