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ADA offers Q&A primer on opting in or out of Medicare

August 20, 2014

In response to member questions, the ADA Practice Institute has put together the following Q&A to help clarify which practitioners should opt in or out of Medicare.

Dentists who treat Medicare patients must either enroll in the program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans.

The requests to the ADA for more information came in response to a June 16 ADA News article alerting dentists to the program requirements.

Q: I read the June 16 article in the ADA News that I have to opt in or out of Medicare or else Medicare won't pay for the prescriptions I write for my patients who have Medicare Part D prescription drug coverage. How do I go about this?

A: In order for Medicare to pay for prescriptions under Medicare Part D, a dentist must do one of the following:

  • Enroll as a Medicare provider
  • Opt-out of the Medicare program.
  • Enroll as an ordering/referring provider.

Q: If I opt out of Medicare, will my Medicare eligible patients still receive their Part D prescription drug coverage?

A: Yes, as confusing as this may be, once a dentist is in the Medicare system either by enrolling in or opting out, patients are eligible to receive their Part D prescription drug coverage.

Q: If I already enrolled as a Medicare ordering/referring provider do I need to take more action?

A: No. Since you are now in the system, your Medicare patients will be eligible for Part D prescription drug coverage.

Q: What happens if I choose not to do any of the above?