The carriers know their margins.
Dentists need to know theirs.
Medicare Advantage is changing across the market. The next contract you sign could affect far more than the patients named in the latest carrier notice.
A full schedule used to feel like proof that a dental practice was doing well. Today, you can fill every chair, run your team into the ground, and still watch your margin disappear.
You can be busy and underpaid at the same time. You are a business owner who happens to be a dentist. If you measure success only by patient volume, you are running a clinic. If you want to keep your private practice private, you need to know what your contracts actually earn you.
Medicare Advantage is making that distinction impossible to ignore.
The market is moving
UnitedHealthcare
Added coinsurance for nonpreventive services on comprehensive Medicare Advantage dental plans. Periodontal maintenance (D4910) is no longer covered on preventive-only plans.
Read the provider noticeHumana
Planned Medicare Advantage exits are expected to affect approximately 600,000 members. Humana says benefit adjustments and targeted exits are part of its effort to improve margin.
Read the earnings transcriptAetna
Connection Dental participation will no longer, by itself, make a provider in-network for Aetna Medicare Advantage dental plans. Connection Dental participation and Aetna commercial access remain separate matters.
Your patient is not the problem. The carrier made the change.
When a patient learns that a benefit disappeared or their dentist is no longer in-network under a particular plan, your front desk gets the call. Your staff gets the frustration. The dentist gets asked to accept a lower-paying agreement to make the problem go away.
That places responsibility on the wrong party. You did not remove D4910 from a UnitedHealthcare preventive-only plan. You did not decide which Humana plans to exit. You did not request Aetna’s change to its Connection Dental Medicare Advantage access. In these examples, the patient’s carrier made the decision. The dentist was not consulted.
Be compassionate. Verify the exact plan, including any out-of-network benefits. Explain estimated patient responsibility before treatment. Continue to welcome patients where you can. And tell them plainly who changed their plan:
“Your insurance company changed the benefits or network arrangement for your plan. Our office did not request this change and was not consulted. We will help you understand your current benefits and what your care may cost. If you disagree with the change, please tell your insurance carrier directly.”
Your staff should help patients through the change. They should not be trained to apologize as though the practice caused it.
Stop solving a new problem with an old contracting playbook.
The standard advice is predictable: a carrier changes something, the dentist fears losing patients, and someone recommends another contract. That advice is often based on a view of dental networks that is years out of date.
Most practices already have overlapping contracts. A carrier may reach the same office through a direct agreement, a leased network, or another relationship the office has never mapped. The name on the insurance card does not reliably tell you which agreement controls the fee. Signing one more contract may do far more than preserve access to the handful of Medicare Advantage patients who prompted the call.
Many offices are grossly overcontracted. Maintaining every agreement is a service someone can sell you. Determining which agreements your practice actually needs is the harder work.
If you are paying someone year after year to keep recredentialing you across a growing stack of agreements, ask a more basic question: Why do we need all these contracts?
An analysis of only the affected Medicare patients is incomplete. An analysis of only that carrier’s patients may still be incomplete. You need to know the effect across every plan that can reach your office through the agreements you already have. Old methods, generic fee comparisons, and a report showing a full schedule will not answer that.
Find out who your advisor really works for.
Before you ask a company to represent your practice, ask what might limit its advice. Does it have an NDA or financial relationship with a carrier or network? Who owns the company? Does a parent company have interests that could benefit from a contract or network it recommends? Ask for the answers in writing.
Pay attention to what happens after you hire them. If you suddenly become “eligible” for another service, or receive an unsolicited offer tied to a relationship you did not ask for, treat it as a red flag. Stop and ask who benefits, how you were selected, and whether your information or business relationship is being used to sell you something else.
A sales pitch about how a relationship “helps providers” does not answer the conflict question. Calling an NDA “standard” does not tell you what the company cannot disclose. Calling ownership “just a corporate structure” does not tell you whose interests shape the recommendations.
If someone has a material limitation, you deserve to know it before you rely on their advice. If they will not disclose it, do not hand them control of your contracting decisions.
Actual carrier payouts. Independent advice. In writing.
Solutions 101 has spent more than a decade studying dental reimbursement for dentists. We have the largest database of dental reimbursements in the country, built solely for the benefit and use of our clients. We are not guessing what fee schedules exist in the market. We make informed decisions using the amounts carriers actually paid on real claims.
We map contracts, identify plans and groups, trace reimbursement, and measure the financial effect across the practice. We do not stray from our process because it works.
We have reviewed carrier depositions and legal briefs, participated in that work, and been retained as expert witnesses. We have seen how these systems operate beyond a sales presentation.
We have zero carrier NDAs. We are independent, and we put that independence in writing. We work for the provider. We can follow the data to the answer—even when the right answer is to reject an offer, remove an unnecessary contract, add a contract, or make no change at all.
Get the whole picture before you sign.
Carriers do not abandon their margin goals because a dentist is uncomfortable with a change. Humana has been explicit with investors about its margin goals. Dentists should be just as clear about their own.
Before signing another Medicare Advantage-related agreement, demand clear answers:
- What do we collect from the affected patients today?
- Which other plans reach us through existing contracts?
- Which agreement and fee schedule govern each plan now?
- What changes across the entire practice if we sign?
- How long are we committed, and how can we exit?
- Will our advisor disclose its relationships and restrictions in writing?
If your goal is simply to keep every chair full, these questions may feel inconvenient. If your goal is to protect your margin, care for patients, and keep your private practice private, they are the questions that matter.
The carriers have the full picture of their business.
Do not make a long-term contracting decision from half the picture of yours.