Delta Dental Medicare Advantage Network
Starting in 2026, Delta Dental of Illinois will provide dental coverage for Clear Spring Health Medicare Advantage members—currently over 8,000 and growing. Delta Dental PPO® network dentists in Illinois are automatically included in our Medicare Advantage network unless they opt out, offering a valuable opportunity to expand their patient base.
To support this program, Delta Dental of Illinois is partnering with Delta Dental of Michigan to manage eligibility, claims, and customer service, leveraging their expertise in Medicare Advantage administration.
Why participate in the Delta Dental Medicare Advantage Network?
Participating in the Medicare Advantage network helps grow your practice by welcoming new patients and continuing care for existing ones as they retire. Enrollment in Medicare Advantage plans across Illinois has doubled over the past decade, and continues to rise, making this a timely opportunity to expand your reach.
Medicare Advantage FAQ
- What is a Medicare Advantage Plan?
Medicare Advantage Plans are an alternative to Original Medicare, primarily for ages 65 and older. They are private company-run health plans (also known as “Part C” or Medicare Advantage plans). Some plans offer extra benefits that Original Medicare doesn’t, like vision, hearing and dental. Clear Spring Health contracted with Delta Dental of Illinois to provide these extra dental benefits.
- What is the difference between Medicare and Medicaid?
- Medicare is health coverage primarily for persons age 65 and older.
- Medicaid gives health coverage to those with limited income and resources.
Joining the Delta Dental Medicare Advantage network does not enroll dentists as a Medicaid provider.
- Is all Medicare the same? Which type covers dental services?
No. Typically, Medicare does not cover dental care. Only Medicare Part C, also called Medicare Advantage (MA), would cover routine dental services payable to dentists. Medicare Advantage is offered through private insurance companies that contract with Medicare to provide Part A (hospital insurance) and Part B (medical insurance) benefits.
- What is the reimbursement for the Medicare Advantage network?
Dentists will be reimbursed using the same Delta Dental fee schedule used for your Delta Dental patients. Same reimbursement, new opportunity.
- How are non-covered services reimbursed?
You must present a standard non-covered service treatment plan signed by the patient prior to delivering treatment. This will ensure your Medicare Advantage patients have a full understanding of their financial responsibility for the non-covered treatment outlined in their treatment plan.
- What is covered under Clear Spring Health Medicare Advantage dental plans?
Clear Spring Health Medicare Advantage Plans provide:
- 100% coverage on most dental services
- Annual maximums from $1,500 to $3,000
- Office copays vary between $0 and $30.
- Plans include major services like crowns, bridges and implants.
Dental offices should verify patient eligibility and benefits on the day of their appointment.
- When is the office copay collected from Medicare Advantage patients?
Patient copays are due at the time of treatment. For multiple visit procedures, such as crowns and dentures, only one copay is charged.
- How do dentists check Medicare Advantage benefits?
- Where do Delta Dental Medicare Advantage dentists send claims?
Delta Dental
Attn: Medicare Advantage
PO Box 9215
Farmington Hills, MI 48333
Payor ID: ILCMS
- What are the compliance requirements for the Medicare Advantage network?
For Illinois dentists, compliance requirements are outlined in the “Delta Dental Medicare Advantage™ Network Regulatory Amendment” to the Delta Dental PPO™ Participation Agreement. If you have questions about this, please contact our professional relations department at 630-718-4990 or pr@deltadentalil.com.
For dentists contracted in other states, please contact your local Delta Dental member company with any questions on your compliance requirements
- Are there unique requirements dentists need to be aware of when treating Medicare Advantage patients?
- Verify patient eligibility and benefits on the day of their appointment.
- Inform the patient of the cost for non-covered services and obtain a financial agreement or signed treatment plan.
- Only one staff member per office must complete annual Fraud, Waste and Abuse & Compliance Training, as well as any other training that may be required. Each office must certify that they have completed this training annually by filling out and submitting our attestation form. Most offices state this takes an hour per year to complete.
Medicare Advantage Network Participation FAQ
- If I am currently a Delta Dental PPO dentist, am I automatically in the Delta Dental Medicare Advantage network?
For Illinois Medicare Advantage network dentists, there is no further action required except to uphold the Delta Dental Medicare Advantage network compliance requirements outlined in the Delta Dental Medicare Advantage Network Regulatory Amendment to the Delta Dental PPO Participation Agreement. If you have questions about this, please contact our professional relations department at 630-718-4990 or pr@deltadentalil.com.
For dentists contracted in other states, please contact your local Delta Dental member company with any questions related to your provider Medicare Advantage network agreement
- May I treat Medicare Advantage patients as a Delta Dental Premier dentist?
If you are a contracted Medicare Advantage network dentist, you will be paid on your contracted PPO or Premier fee schedule. If you have questions, contact your local state Delta Dental Professional Relations department. If you are an Illinois contracted Medicare Advantage network dentist, please contact Delta Dental of Illinois’ Professional Relations Department at pr@deltadentalil.com.
- If I decide to sign the non-participation waiver for the Delta Dental Medicare Advantage Network, will it remove me from all locations where I currently participate?
Yes, the non-participation form for the Medicare Advantage network is applicable to all your Delta Dental locations in Illinois. However, this does not affect your Delta Dental network participation.
- If I terminate from the Delta Dental Medicare Advantage network, do I need to terminate from the Delta Dental network as well?
No, if you terminate from the Delta Dental Medicare Advantage network, it will not impact your Delta Dental network participation.
- If I terminate from the Delta Dental network, can I remain in the Medicare Advantage network?
No, once you exit Delta Dental network, you will also be removed from the Delta Dental Medicare Advantage network.