August 2025 ISSUE
August 1, 2025
By Shelly Ryan & Bill Rossi*
Most doctors like their senior patients, as they usually have more needed dentistry to do. They show up for their appointments and usually pay on time. You don’t want to lose those valuable patients. Yet, do you want to treat them at a loss?
While traditional Medicare doesn’t cover dental procedures, Medicare Advantage does. Medicare Advantage plans have exploded in popularity recently, with 55% of the Medicare population now covered. That’s nearly 34 million seniors. There are hundreds of different Medicare Advantage Plans**, and many change every year. For example, UHC is the largest Advantage Plan nationally, and they alone have over six different dental plans. There are a few that are very generous — essentially giving a participant $2,000 to $3,000 per year to spend on dentistry and/or vision care.
However, most have low fee schedules for participating providers – as bad or worse than most PPOs. Medicare Advantage ads are very misleading, promising low cost options with lots of extra benefits, including “free” dental and vision. It’s pretty disingenuous for the Medicare Advantage Plans to say “We give you dentistry along with Medicare coverage…” but what really happens is you (the dentist) are the one giving the patients essentially free dentistry, by providing the services at your cost or even less.
Our advice is that generally your practice should not participate with Medicare Advantage Plans — with few exceptions (e.g., if there is a plan that pays well and has a dominant presence in your area).
If retaining your senior patients becomes an issue, we recommend the following verbiage:
“Mrs. Smith, we do not participate in Medicare Advantage Plans, however, we do offer our seniors a 15% savings for payment in full made at the time of service. We will process the claim for you and forward a check to you for whatever your plan pays.”
“There’s a confusingly large number and variety of Medicare Advantage Plans, so we feel this is the simplest and fairest approach. It’s a very good alternative for our seniors and helps us make dentistry comfortably affordable. We hope that you will take advantage of it!”
The above approach has several advantages:
- You can look your senior patients in the eye and know that they’re still getting a very good deal — a 15% savings is a good deal! Yet your practice isn’t taking 30% to 50% discounts.
- It’s very easy for your admin team to deal with. They just quote your fee, less 15%, for payment at the time of service. No need to know the nuances of each plan. And since payment is required at the time of service, there’s no billing or collection efforts required. That saves your practice time and money!
- Some seniors will still only go to participating providers, so you will lose some patients. Yet, most seniors value and trust their dentist for more than just their in-network participation.
Many seniors are watching their budget closely. If they choose to go to another dentist that participates in Medicare Advantage, it’s always good to be graceful about it. We recommend telling them: “We hate to see you leave our practice but we understand. If your circumstances change later, you are always welcome back here.” Guess what, some of them will end up returning!
The bottom line is that Medicare Advantage Plans are here to stay, and they are growing. However, be very wary about participating in them. The number one thing is to continue to do all the good stuff you do, so patients want to continue to see you — not because you participate with Medicare Advantage — but because you treat them well! Even without participating, you’ll see that seniors in general will be loyal to your practice if you take good care of them.
*Bill Rossi and Shelly Ryan have decades of practice management experience helping private independent practices succeed. For more information on their firm’s PPO Strategies and other practice management services, call 952.921.3360, or visit AdvancedPracticeManagement.com.
**There are over 100 Advantage plans offered in Minnesota alone. And every county has a different mix of plans available!