Medicare Advantage
Delta Dental PPO® network dentists in Illinois agree to participate in our Medicare Advantage (MA) network (unless they opted out). This provides an opportunity for Delta Dental network dentists that accept PPO to grow their patient base as we expand our Medicare Advantage program in Illinois.
We recently announced a new partnership between Delta Dental and Devoted Health Plans, a rapidly growing regional health care partner for Medicare Advantage. Here are some Frequently Asked Questions about the Delta Dental of Illinois Medicare Advantage opportunity below.
Why participate in the Delta Dental MA network?
Adding Medicare Advantage patients to your practice provides an opportunity to increase the number of patients at your office and simultaneously provide treatment for existing patients as they transition into retirement. The number of Illinois residents enrolled in Medicare Advantage plans continues to rise, with more than 300,000 people now covered. Enrollment in Medicare Advantage plans has doubled over the past decade and 27% of all Illinoisans are enrolled in Medicare Advantage.¹
What is the reimbursement for the Medicare Advantage network?
Dentists will be reimbursed using the same Delta Dental PPO fee schedule used for your Delta Dental PPO 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. For questions regarding Devoted Health plan information and member benefits, please contact 855-251-9742 or visit us here.
If I am currently a Delta Dental PPO dentist, am I automatically in the Delta Dental MA network?
Yes, 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, included in the Delta Dental Medicare Advantage network packet mailed to you. If you have questions about this please contact our professional relations department at 630-718-4990 or pr@deltadentalil.com.
Isn’t Medicare basically the same as Medicaid?
No. Medicare is the federal health insurance program for individuals aged 65 or older, younger individuals with certain disabilities, and individuals with end-stage renal disease. Medicaid is a joint federal and state program for individuals and families who may have incomes that make them eligible for Medicaid.
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.
May I treat Medicare Advantage patients as a Delta Dental Premier dentist?
No, to qualify as an in-network Delta Dental Medicare Advantage network dentist you must participate in the Delta Dental PPO™ network. If you would like to enroll in our Delta Dental PPO™ please contact Delta Dental of Illinois’ Professional Relations Department at pr@deltadentalil.com to request a Delta Dental PPO contract.
If I decide to sign the non-participation waiver for the Delta Dental Medicare Advantage Network, will it remove me from all PPO locations where I currently participate?
Yes, the non-participation form for the Medicare Advantage network is applicable to all your Delta Dental PPO locations. However, this does not affect your Delta Dental PPO network status.
What are the compliance requirements for the Medicare Advantage network?
Compliance requirements are outlined in the “Delta Dental Medicare Advantage™ Network Regulatory Amendment” to the Delta Dental PPO™ Participation Agreement included in the Delta Dental MA network packet mailed to you. If you have questions about this, please contact our professional relations department at 630-718-4990 or pr@deltadentalil.com.
What type of annual training does our office have to do?
Only one staff member per office must complete an annual Delta Dental of Illinois’s Fraud, Waste and Abuse & Compliance Training, as well as any other training that may be required. Each office simply certifies that they completed or will complete this training annually. Most offices state this takes an hour per year to complete.
If I terminate from the Delta Dental Medicare Advantage network, do I need to terminate from the Delta Dental PPO network as well?
No, if you terminate from the Delta Dental Medicare Advantage network, it will not impact your Delta Dental PPO network status.
If I terminate from Delta Dental PPO, can I remain in the Medicare Advantage network?
No, once you exit Delta Dental PPO, you will also be removed from the Delta Dental Medicare Advantage network.
What if I practice at one Delta Dental PPO location that agrees to participate in the Delta Dental Medicare Advantage network, and I practice at a different Delta Dental PPO location that decides not to participate in the MA network, am I considered in the Medicare Advantage network at Delta Dental PPO locations that are participating?
No, participation or non-participation in the Medicare Advantage network is applicable to all your Delta Dental PPO locations.
How many patients utilizing this program are local?
We are building a Delta Dental Medicare Advantage Network to ensure we meet sales opportunities. Illinois statistics indicate more than 300,000 Illinois residents are enrolled in an MA plan. Our current opportunity with Devoted Health will bring approximately 40,000 new members to Delta Dental in several states, including Illinois. People who chose a Devoted Health plan during this year’s Medicare Advantage Enrollment Period will have Delta Dental benefits as of January 1, 2023.
¹ Henry J. Kaiser Family Foundation, Medicare Advantage 2017 Spotlight: Enrollment Market Update. https://www.kff.org/medicare/issue-brief/ a-dozen-facts-about-medicare-advantage-in-2020/ (accessed J April 2021).