My Medicare Advantage plan covers dental, but I can't find a dentist who accepts it. Is this a common problem?
Answered by 23 licensed agents
Yes, not all plans use the same carrier for dental, and some differ between HMO and PPO. However they all have a provider search tool that we can assist with.
Not generally. That is something to research before you sign up. Same with doctors and’s vision. If you dentist doesn’t take the plan, it never hurts to ask if they would consider it. The companies are usually looking for more providers.
Not necessarily, depending on the Insurance company utiliized and the member portal if the member understands how it works. Many new and old members of United Healthcare have been educated on how to search the directory on their member portal by their local agents outreach and the education during the enrollment process. We also hold member appreciation meetings bi-annually to continue with the latest news and updates for our members. If a member already has a dentist they prefer to deal with, and the dentist is not in the network, the dentist can charge 15 percent higher than the negotiated rate of the insurance company. However, if the member files a claim through their member portal, they will be reimbursed for the rate the insurance company will pay for certain procedures. This varies upon each insurance company and their limitations & exclusions of course.
This can definitely be a major frustration! Your dentist should be checked ahead of enrolling in the plan as part of ensuring everyone you see is in network, if your dentist does not take any insurance you can pay them up front and submit a claim for reimbursement to your Medicare Advantage carrier for them to pay you back.
Yes, finding a dentist who accepts your Medicare Advantage dental plan can be a common challenge. Many private dentists don't accept Medicare plans due to low reimbursement rates and other factors. Medicare Advantage plans often offer limited dental coverage, which may not be sufficient for dentists to accept.
Here's a more detailed explanation:
Low Reimbursement Rates:
Dentists may refuse to accept Medicare Advantage plans because the reimbursement rates are low, potentially making it difficult to cover their costs.
Limited Coverage:
Medicare Advantage plans may only cover a limited range of dental services or have high copays, making them less attractive to dentists who prefer to work with patients who can cover the full cost of their services.
Administrative Burden:
Dealing with Medicare's administrative procedures can be complex and time-consuming for dentists, which may lead them to prefer patients who have easier-to-manage insurance plans.
Patient Expectations:
Some patients may have unrealistic expectations about dental coverage under Medicare, which can lead to dissatisfaction and difficulty managing patient relations.
What to do if you're having trouble finding a dentist:
Review your plan's "Evidence of Coverage":
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This document outlines the specific benefits and limitations of your plan, including information on dental coverage.
Contact your plan's customer service: They can provide you with a list of in-network dentists and help you understand your coverage. Use your plan's online directory: Many plans have online tools that allow you to search for in-network dentists based on your location and specific needs.
Consider "out-of-network" benefits: Some plans may offer limited out-of-network coverage, but it's likely to come with higher cost-sharing.
Be patient and persistent:. Finding a dentist who accepts your plan may require some effort, but it's worth it to ensure you're able to access the dental care you need.
Yes it is. As they say...the devil is in the detail. When a Medicare Advantage Plan offers "dental" coverage, it can mean a lot of things. Is it "first dollar dental", meaning that you have a pot of money to draw from, usually without having to pay anything first. Is there a "network" associated with the dental coverage offered. Is it an HMO dental plan or PPO? If you have a good Independent Broker, they know things like this.
Depends on who youre with. My suggestion is to find out who your dentist and Dr take. See if you can replace it when open enrollment comes up. There are some discount dental plans you can use during the meantime
No, you should be able to access the dentist who are participating by calling member services or go on your member website to look up the dentist who are participating with your Medicare advantage carrier.
Situations difer depending on the type of provider being searched. The best thing to do is call the Customer Service area at the company you are covered by and explain that you cannot find a dentist anywhere near your home and let them look into the situation. Often times the company has names of providers that for whatever reason are not listed on the web portal covered people have access to.
That does not happen often! Simply call Customer Service on the back of your advantage plan Wallet card, and the carrier will help you find providers… Once in a while I’ve run into a similar problem, but the Insurance companies have additional resources and provider lists that they can point you to!
It’s frustrating, but you’re not alone—lots of people have this same issue. It just means you might have to do a little extra searching to find a dentist who accepts your plan. That's where I will come in. I will either have a list of dentist in your area that work with an Advantage plan if you choose one or, I will do the work for you IF you chose an Advantage plan.
No, it is not a common problem. The best way to locate a dentist is to search for one on the companies website where you have your Medicare Advantage plan.
A lot of MA plans cover dental, to an extent. However, Medicare does not reimburse the plans for this benefit so the carrier comes out of pocket, often times leading to smaller/limited networks. So, in short, the answer is yes more often than not.
I wouldn't say it is a common problem but it does happen. It is very important to check all of your Doctors, Dentist, etc before choosing a Medicare Advantage Plan. Most Advantage plans give a set dollar amount per year to use for dental services. In my area, many (not all) of those plans will pay the same on dental services regardless if the dentist is in or out of network. I would recommend checking your plan's Summary of Benefits to see how your plan's dental benefits work out of network. You can request a book or go to your plan's website to find that info.
Many dentists do not contract directly with insurance companies, however, if your plan is a PPO plan, you should still be able to utilize those dentists. Be sure to ask your dentist if they will still file the claim for you, even if they are not in the network, so you can utilize the plan benefits.
You're 1000% NOT the only person frustrated by this. A lot of Dentists sometimes work on a separate network all together from the one your PCP may use. So here's what I'd suggest, call the number on the back of your card for Member Services and ask for the dental network name. You can search the carriers website for in-network dentists near where you live. Lastly, if you feel like that network is just too limited, consider this to be something to review during AEP and/or consider adding on a stand alone dental policy! Hope this helps.