Medicare Advantage Update for Providers Who Opted Out of Medicare

Currently, Northeast Delta Dental offers two Medicare Advantage plans, Martin’s Point Generations Advantage (MPGA) and WellSense Medicare Advantage (WellSense MA). For Medicare Advantage plans, please note that in 2022, Centers for Medicare and Medicaid Services (CMS) finalized a rule clarifying that Medicare opt-out status no longer applies to supplemental benefits.

What does this mean to you?

• Effective January 1, 2022, providers who have opted out of Medicare will no longer have their claims for MPGA and WellSense MA patients denied due to their opt-out status. Claims will pay based on the benefits available under the plan selected by the patients, for the date services are provided, just like any other Northeast Delta Dental group.
• Claims submitted to Northeast Delta Dental for MPGA and WellSense MA patients are processed using the Northeast Delta Dental Premier MAC and PPO fee schedules, not the reduced Medicare fee commonly seen with medical claims submitted to Medicare.
• Your name and practice location will now be listed as a participating provider when Martin’s Point Generations Advantage or WellSense Medicare Advantage plan is selected on our “Find a Dentist” tool located on nedelta.com.

Please be aware that subscriber ID cards for MPGA and WellSense MA patients are different than what you typically see for Northeast Delta Dental patients. 

Dental offices can check patient eligibility and benefits online at www.nedelta.com or call our Customer Service Department at 1-800-832-5700.