Your patients are turning 65. Some of them are about to bring an insurance plan you don’t accept.
The Shift Is Already Here
In 2007, about 19% of eligible Medicare beneficiaries were enrolled in Medicare Advantage. By 2025, that number reached 54%, roughly 34 million people, according to KFF. The Congressional Budget Office projects it will reach 64% by 2034.
Many Medicare Advantage plans bundle dental benefits. That means a growing share of your longtime patients will reach 65, change plans, and suddenly carry dental coverage that your current contracts may not touch.
Most practices find out the same way: a loyal patient calls, asks if you take their new plan, and the answer is no.
Why This Is a PPO Strategy Question
Medicare Advantage dental benefits are usually administered by dental carriers and networks, often names you already know. But participating in a carrier’s commercial PPO does not automatically put you in its Medicare Advantage network. These products can carry separate contracts, separate fee schedules, and separate credentialing.
So the real question isn’t “Should we take Medicare?” It’s this: which Medicare Advantage dental networks belong in your portfolio, and on what terms?
Five Questions to Answer Before You Decide
- How many of your active patients are 60 or older? That group will age into Medicare Advantage over the next few years.
- Which carriers administer Medicare Advantage dental benefits in your market? The answer varies by region and by plan.
- What do those fee schedules actually pay? Compare them against your commercial schedules on your 20 most frequently performed procedures.
- Do you have the chair time? Adding a network that fills hygiene with lower-reimbursing visits can crowd out more profitable work.
- What happens if you say no? Estimate how many patients you could lose and what their lifetime value is.
The Cost of Waiting
Practices that wait end up making this decision reactively, one patient at a time, after those patients have already started looking elsewhere.
Practices that plan ahead can choose their path deliberately. They can participate directly, reach these patients through a rental network, or decline with a clear retention plan. Any of those can be the right answer. Not deciding is the only wrong one.
How We Evaluate It
During a PPO Participation & Optimization Assessment, we break down your payor mix by age group, identify which Medicare Advantage networks are active in your area, and run every option through our Fee Schedule Comparison Matrix. You get a recommendation built on your patients and your capacity, not an industry average.
Find out where your practice stands before your patients decide for you. Request your complimentary PPO Revenue Assessment.
👉 https://pponegotiationsolutions.com/insurance-survey/
