How to opt out of Medicare

If the administrative burdens of accepting Medicare patients have become too onerous, you can opt out of the program. This will let you set your own fees free of Medicare’s limiting charges, but the process comes with some complicated requirements.

First, submit an affidavit formally opting out of Medicare to any Medicare contractors that normally process your claims. Many contractors offer sample opt-out affidavits on their websites. You must submit these affidavits at least 30 days before the next calendar quarter begins and include an effective date of the first day of that calendar quarter.

Next, enter into private contracts with Medicare patients. These contracts must make clear that Medicare payment limits do not apply to what you may charge, that the patient agrees not to submit a claim to Medicare or ask you to submit a claim on his or her behalf, that no Medicare payment will be made for any items or services provided that would otherwise be covered by Medicare, and that patient may obtain Medicare items or services from other physicians who have not opted out.

Finally, make sure you do not violate your Medicare opt out, which can result in significant financial consequences. A violation occurs if you knowingly and willfully submit a Medicare claim during the opt-out period (except for emergency or urgent care services) or if an entity employing you submits a Medicare claim and you receive payment indirectly. Also, it is a violation if you treat a Medicare beneficiary with whom you have not entered into an appropriate private contract.

Adapted from "Opting Out of Medicare: How to Get Out and Stay Out."