Opting Out of Medicare
Section 4507 of the Balanced Budget Act of 1997 allows certain Medicare physicians and practitioners "opt-out" of Medicare for two years. This applies to all covered items and services that the provider furnishes to Medicare beneficiaries.
In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner, and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.
Participating physicians and practitioners may opt-out by filing an affidavit that meets the established criteria and which is received by the Carrier at least 30 days before the first day of the next calendar quarter showing an effective date of the first day in that quarter (i.e. 1/1. 4/1. 7/1. 10/1). Their participation agreement will terminate at that time. They may not provide services under private contracts with beneficiaries earlier than the effective date of the affidavit. Non-participating physicians and practitioners may opt-out at any time.
A more detailed description of opting-out of the Medicare program, opt-out Frequently Asked Questions, a downloadable opt-out affidavit, and a list of physicians and suppliers that are currently opted out is also available in this segment.
Additional Section Links
- Opting Out of Medicare: Private Contracts Between Beneficiaries and Physicians/Practitioners
- Opt-Out Affidavit
- Physicians and Suppliers Who are Currently Opted Out
- Frequently Asked Questions About Opting Out
