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• Opting Out of Medicare

Opting Out of Medicare

Since January 1, 1998, physicians have been permitted to opt out of Medicare and enter into private contracts with Medicare beneficiaries that allow them to set their own fees.  A physician who opts out of Medicare agrees not to see any Medicare patients (barring emergencies or urgent services), except for those with whom she has entered into private contracts, for a period of two years.

This means that if you work in a situation where you must see Medicare patients as a part of your employment, you cannot opt out of Medicare.  It also means that if there is any possibility that your life will change in the next two years, and you may have to see Medicare patients as part of new managed care contracts or new employment, you also should not consider opting out of Medicare.

The rules for opting out are very specific.  In order to opt out you must file an opt-out affidavit with your Medicare Carrier, or Medicare Carriers (if you work in more than one Carrier jurisdiction).  A template for this affidavit that conforms to Medicare rules is available in the document below. A private contracting template is also included, which you can use for entering into private contracts with your Medicare patients once you have opted out.  These contracts must be kept on file in your office, available to be sent to the Carrier or to the Centers for Medicare and Medicaid Services (CMS), which oversees the Carriers, should they be requested. New affidavits and private contracts must be completed every two years.

Notice and Disclaimer:  Opting out has serious implications for your status, rights, and responsibilities as a Medicare provider.  This summary and the sample affidavit and private contract template are based on sources believed to be reliable.  The information contained herein doesn’t constitute legal advice nor should it be relied on exclusively.  The APA assumes no responsibility for any physician’s decision to opt out or reliance on the sample agreements that follow.  APA Members with questions concerning these materials or opting out in general, may call the Managed Care Help Line (800-343-4671).