Opting Out of Medicare: What You Need to Know

Opt-out affidavits submitted after June 16, 2015 will automatically renew every two years. If you submitted your affidavit prior to June 16, you must renew your status when the two years are up, but thereafter your status will automatically renew unless you notify Medicare otherwise. The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in April, which most notably eliminated the sustainable growth rate budget cap, also led to changes for physicians seeking to opt out of Medicare.

For more than 15 years, physicians have been permitted to opt out of Medicare and enter into private contracts with Medicare beneficiaries with whom they set their own fees. Before June 15, physicians who opted out of Medicare agreed not to see any Medicare patients (barring emergencies or urgent services), except for those with whom they have entered into private contracts, for a period of two years. However, as of June 16, all opt-out affidavits automatically renew for two years at the end of each two-year period.

If you submit opt-out affidavits to Medicare, this means that you no longer have to submit a new affidavit every two years if you wish to retain your opt-out status. If you wish to end your opt-out status, you must inform the Medicare Administrative Contractor (MAC) that maintains your opt-out status of that decision at least 30 days before the start date of the next two-year period.

If your decision to end your opt-out status signals that you want to become a Medicare provider, you must also complete a Medicare enrollment application at that time. Informing the MAC that you want to end your opt-out status will not automatically make you a Medicare provider; it merely eliminates your opt-out status—and effectively means that you can’t see any Medicare patients at all until you enroll.

All MACs should now have new opt-out affidavits posted on their websites that reflect automatic renewal, and we suggest that the online affidavit be used in lieu of the affidavit available on the APA website (see link below) because sometimes MACs ask for information that, although not required under law, they insist on receiving before completing the opt-out process. For instance, the California MAC Noridian insists on seeing a copy of the private contract that will be used with the physician’s signature before it will complete the process.

A private contract template that reflects the new continuing opt-out rule can be accessed here.

Note: If you have no status with Medicare (you are neither enrolled nor opted out), Medicare will not cover your patient referrals to other physicians, nor will it cover any medications you prescribe. Because of this, Medicare now allows you to enroll in its system solely to order and certify items and services and/or prescribe Part D medications for Medicare patients (who presumably you see pro bono). Information on this option can be found here.

Have a question or comment on Medicare or other practice-related issues? Contact APA’s Practice Management HelpLine at (800) 343-4671 or [email protected].