Understanding Why Most Practices Don't
The General Answer for this question is that some may, but many don’t.
What About Our Office?
If you’re asking specifically about Galligan Family Dentistry:
- We do not accept Medicaid
- We are out-of-network with all Medicare plans
- We cannot file Medicare or Medicaid claims on your behalf
If you have either of those benefits listed above, you would be responsible for payment in full at the time of service, and you would need to submit any claims to your plan yourself.
We can provide:
- Clinical notes
- X-rays
- Intraoral photos
- Any documentation your plan requests
But we do not submit or manage Medicare claims, and we cannot guarantee any reimbursement.
Also important:
- Medicare HMO plans specifically, will never provide you out-of-network benefits at our office
- Some PPO or PFFS plans may allow you to submit claims independently, but that varies by plan
If that answers your question, that’s exactly why we put it here first.
If you’d like to understand why it works this way, and why many dental offices handle these plans differently, the full explanation can be found below.
Why This Topic Comes Up So Often
We hear this every day:
- “Do you take Medicare?”
- “Do you accept Medicaid?”
And it’s a fair question.
Dental insurance is confusing, and government-based plans can be even more difficult to navigate. Our goal is to give you a clear answer upfront so you can avoid frustration, surprises, or wasted time.
The Reality: Not All Dentists Participate
Some dentists do accept Medicaid and certain Medicare plans, but participation varies widely.
In North Carolina, for example, only about 45% of dentists accept Medicaid, and even among those who do, many limit availability or are not accepting new patients. There are currently no statistics available to the public regarding which practices, or percentage of practices accept Medicare.
That’s why it’s always important to verify before scheduling.
What Medicare and Medicaid Actually Cover
These programs are not structured like traditional dental insurance.
Medicaid:
- Coverage varies by state
- Reimbursement rates are often low
- Many offices do not participate
Medicare:
- Traditional Medicare (Part A and B) generally does not cover routine dental care
- They can cover dental procedures that are a result of, or a part of, hospital-based procedures only.
- Medicare Advantage plans may offer dental benefits, but:
- Coverage varies widely
- Restrictions are common
- Network rules apply
Why Medicare Can Be Difficult to Use
Even when a Medicare Advantage plan includes dental coverage, there are important limitations.
Because we are out-of-network, here’s what that means in practical terms:
- We cannot submit claims to Medicare on your behalf
- We cannot verify your benefits in advance
- We cannot estimate what your plan will reimburse
For patients with PPO or PFFS plans, there may be out-of-network reimbursement available, but:
- You must submit claims yourself
- Reimbursement is determined entirely by your plan
- Payment is not guaranteed
For patients with HMO-based Medicare plans:
- Care is restricted to in-network providers
Our office is not eligible for reimbursement under those plans
Why We Set Expectations Early
We are a family-run practice, and we care deeply about the experience our patients have, from the first phone call to every visit that follows.
That includes:
- Avoiding unexpected costs
- Preventing confusion at checkout
- Making sure you feel informed, not surprised
By explaining this upfront, we can help you decide what works best for your situation before you ever come in.
What We Can Do to Help
Even though we cannot file Medicare claims, we still support our patients by providing:
- Complete documentation for self-submission
- Clear treatment plans and costs upfront
- Answers to questions about your care
If you plan to use Medicare benefits, we strongly recommend contacting your plan administrator first to confirm:
- Whether out-of-network reimbursement is available
- What procedures may be covered
- What documentation is required
For Patients with Private Insurance
If you have traditional private dental insurance, the process is much more predictable.
We will:
- Verify your benefits ahead of time
- Provide clear estimates before treatment
- File claims on your behalf
This allows for a much smoother and more transparent experience.
The Bottom Line
Some dentists accept Medicare and Medicaid. Many do not. And even when they do, coverage can be limited or difficult to navigate.
At Galligan Family Dentistry, we:
- Provide clear answers upfront
- Help patients understand their options before scheduling
- Focus on making your experience as smooth and predictable as possible
If you’re unsure about your plan, we’re always happy to help point you in the right direction before you schedule.
Because the best dental experience starts with clear expectations, not surprises.
Reach Out to Our Team
If you live in Wake Forest, North Raleigh, Rolesville, Youngsville, or the surrounding Wake County area, our team at Galligan Family Dentistry is here to help. We provide comprehensive exams, digital X-rays, and same-day treatment when possible, so small concerns don’t turn into bigger problems.
Call us and schedule your visit today to take the next step toward protecting your smile.