Opting Out of Medicare

What Does it Mean to Opt Out of Medicare?

You don’t want to bill Medicare for your services, but instead want your Medicare patients to pay out of pocket. Medicare coverage would apply when you order or certify items and services.

CMS Opt-Out Dataset
To opt out, you will need to:

• Be of an eligible type or specialty
• Submit an opt-out affidavit to Medicare
• Enter into a private contract with each of your Medicare patients. This contract will reflect the agreement between you and your patients that they will pay out of pocket for services, and that nobody will submit the bill to Medicare for reimbursement.

Canceling an Opt-Out Status

To cancel your opt-out status, you’ll need to mail a cancellation request to your MAC at least 30 days before your opt-out period is set to expire. If you don’t submit your cancellation request before the 30-day period, your opt-out status will automatically renew for another two-year cycle.

Early Termination

You can terminate your opt-out status within the first 90 days of submitting an initial opt-out affidavit. (Once an opt-out has been automatically renewed, you can no longer terminate early.)

Renewing an Opt-Out Status

If you’re currently opted out, your opt-out status will automatically renew every two years. If you submitted an opt-out affidavit before June 16, 2015 and never renewed it, you’ll need to submit a new opt-out affidavit.

Providers Eligible to Opt Out

• Doctors of medicine
• Doctors of osteopathy
• Doctors of dental surgery or dental medicine
• Doctors of podiatric medicine
• Doctors of optometry
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Certified registered nurse anesthetists
• Certified nurse midwives
• Clinical psychologists
• Clinical social workers
• Registered dieticians and nutrition professionals
• Marriage and family therapists
• Mental health counselors

Providers Not Eligible to Opt Out 

• Anesthesiology assistants
• Chiropractors
• Occupational therapists
• Physical therapists
• Qualified audiologists
• Qualified speech language pathologists

Telehealth and Opt Out

Opt-out providers offering telehealth services should submit their affidavit in the state where they are physically located, using their home or office address. If a provider with an active opt-out record submits an affidavit listing a different address, the MAC shall return the affidavit and advise the provider to submit their affidavit to the appropriate MAC for processing. If the provider intends to update their address and the new location falls within the current MAC’s jurisdiction, the MAC shall process the change. Affidavits should be filed with all MACs that have jurisdiction over claims the eligible practitioner would otherwise file with Medicare.

Resources

• Medicare Opt-Out Affidavit — Jurisdiction JJ
• CMS Article — Manage Your Enrollment
• Pub. 100-02, Chapter 15, section 40.9 — Requirements of the Opt-Out Affidavit