Do Dentists Accept Medicare and Medicaid?

Why the Answer Varies Among Dental Practices

“Do dentists accept Medicare or Medicaid?” sounds like a yes-or-no question, but it covers three different forms of coverage. Medicaid is administered through state programs. Original Medicare includes Parts A and B. Medicare Advantage, or Part C, is administered by private insurance companies under Medicare rules.

A dental office may enroll in Medicaid, join selected Medicare Advantage networks, treat qualifying out-of-network patients, or decline these arrangements. Participation and plan rules should be confirmed before care.

How Medicaid Dental Coverage Works

Medicaid is a joint federal and state program. North Carolina Medicaid includes dental services, but covered treatment generally must come from an enrolled dentist. Participation and new-patient availability vary.

The North Carolina Department of Health and Human Services provides Medicaid dental provider resources for patients searching for an enrolled dentist. Scanlan Family Dentistry is not enrolled in North Carolina Medicaid. We cannot accept Medicaid, submit Medicaid claims, or seek reimbursement from the program on a patient’s behalf.

How Original Medicare Parts A and B Cover Dental Care

Original Medicare generally does not cover routine dental care. According to Medicare’s official dental guidance, routine exams, cleanings, fillings, dentures, implants, and most tooth extractions are normally excluded.

Limited dental services may qualify when closely connected to certain Medicare-covered medical treatment. These narrow exceptions have specific clinical, documentation, provider, and billing requirements. Having Medicare does not make routine dental care covered.

Our practice does not participate in or file claims with Original Medicare Parts A or B. A patient choosing routine care at our office should not expect Original Medicare reimbursement.

How Medicare Advantage Part C Is Different

Private insurers offer Medicare Advantage plans. Many include supplemental preventive or restorative dental benefits, along with provider networks, annual maximums, copayments, frequency limits, prior authorization, and separate claim procedures.

A Medicare Advantage dental benefit cannot necessarily be used at every dentist. The private carrier and exact dental plan matter, and a separate company may administer the dental benefit.

Why the HMO, PPO, or PFFS Plan Type Matters

Medicare’s plan comparison explains that access outside a plan’s network depends heavily on the plan structure.

• HMO: Most HMOs require routine care from network providers. Some HMO point-of-service plans allow specified out-of-network services, but this is not the usual arrangement.
• PPO: PPO plans commonly allow some out-of-network care, although the patient’s cost may be higher and the dental benefit may have separate restrictions.
• PFFS: Private Fee-for-Service plans establish their own payment terms and conditions. An out-of-network dentist may decide whether to accept those terms for a particular visit.

PPO and PFFS members are most likely to have a possible out-of-network path, but the plan must permit treatment from an out-of-network fee-for-service dentist. No plan type guarantees payment.

Our Medicare and Medicaid Policy

Our policy is different for each form of coverage:

• North Carolina Medicaid: We do not participate, accept Medicaid as payment, or file Medicaid claims.
• Original Medicare Parts A and B: We do not participate, accept assignment, or file Medicare claims.
• Medicare Advantage Part C: We do not participate in Medicare Advantage networks or accept the plan as payment. If a plan confirms that an eligible member may use an out-of-network fee-for-service dentist under its terms, we can provide treatment as a self-pay practice and help the patient pursue reimbursement.

This distinction lets us be accurate without leaving an eligible Part C patient alone with unfamiliar paperwork.

How We Help Eligible Medicare Advantage Patients

The patient should provide the insurer’s name, member ID, plan or group number, and whether it is an HMO, PPO, or PFFS plan. With permission, we will check whether the benefit permits our out-of-network fee-for-service office, what documentation is required, and where to send it.

If the plan confirms a workable reimbursement process, we will:

1. Explain our fees and the plan information we received before treatment.
2. Complete the applicable portions of the ADA Dental Claim Form.
3. Assemble our itemized invoice, procedure codes, and relevant supporting records.
4. Review the packet with the patient and obtain all required signatures.
5. Obtain a signed patient request and acknowledgment confirming that the patient asked for our help and understands that reimbursement is not guaranteed.
6. Mail the patient-authorized packet to the address specified by the plan.

We will make the packet as complete as possible to reduce avoidable delays or rejection. We cannot follow up, appeal a denial, guarantee approval, or promise an amount. It remains the patient’s request, and payment goes directly to the patient.

Payment and Our Senior Cash or Check Discount

Patients receiving care at our office while relying on Medicaid, Original Medicare, or Medicare Advantage coverage must pay the full practice fee at the time of service. Patients age 60 and older receive a 5% discount when paying their balance due in full by cash or check at the visit. Debit and credit card payments do not qualify. This discount is separate from any reimbursement that an eligible Medicare Advantage plan may later send to the patient.

Our senior patient information explains how we support older adults, and our insurance and financial information provides additional background about our practice. Patients comparing these arrangements with conventional private coverage can also read our guide to how dental insurance works.