Medicare Open Enrollment gives eligible physicians, practitioners, suppliers, and organizations an annual opportunity to review and change their Medicare participation status for the upcoming calendar year.

The Open Enrollment period generally runs from November 15 through December 31. Participation elections made during this period take effect January 1 of the following year. Medicare announces the official dates and provides updated participation materials each year.

Do You Need to Take Action?

Your current Medicare participation status automatically renews each year unless you request a change during Open Enrollment.

You Are Participating and Want to Remain Participating

No action is required. Your participation status will automatically continue for the next calendar year.

You Are Non-Participating and Want to Remain Non-Participating

No action is required. Your non-participating status will automatically continue for the next calendar year.

You Want to Become Participating

Action: Complete and submit the CMS-460 Medicare Participating Physician or Supplier Agreement during Open Enrollment.

By signing the agreement, you agree to accept assignment on all Medicare-covered services subject to the agreement.

• Participation Announcement
• Participation Agreement

You Want to Become Non-Participating

Submit a signed written notice stating that you want to terminate your participation agreement at the end of the current calendar year. Include the information needed to identify the individual or organization requesting the change, such as:

• Legal business or individual name
• Tax Identification Number or Social Security Number, as applicable
• National Provider Identifier
• Requested participation status
• Signature of the individual provider or authorized or delegated official

Action: Submit the notice to each Medicare Administrative Contractor with which you filed the participation agreement or a copy of the agreement.
View Noridian Contact Information

Before Changing Your Status

Review how participation and non-participation affect:

• Medicare-approved payment amounts
• Assignment requirements
• Who receives Medicare payment
• What beneficiaries may be charged
• Limiting charge requirements
• MEDPARD eligibility

Participation status is different from opting out of Medicare. Non-participating providers remain enrolled in Medicare and continue to follow Medicare claims submission and billing requirements. Eligible practitioners who opt out follow separate affidavit and private-contracting requirements.

Group Practices and Organizations

When a hospital, medical group, clinic, or other organization bills and receives Medicare payment for physician services under the organization’s name, the organization generally makes the participation election. One participation agreement binds the physicians furnishing services billed by that organization.

When individual physicians bill and receive payment under their own names, each physician makes an individual participation election.

A physician who also maintains a separate practice may make a different participation election for that practice when the physician bills and receives payment under their own name.

Newly Enrolled Physicians and Suppliers

A newly enrolled physician or supplier may submit a participation agreement within the applicable participation election period following enrollment or another qualifying event. A physician or supplier may enter into a participation agreement within 90 days after:

• Becoming newly licensed to practice medicine or another healthcare profession; or
• First opening an office for professional practice or another healthcare business in a Medicare contractor service area or locality.

When accepted under this provision, the agreement is effective on the filing date. The filing date is the date the agreement is mailed or delivered to the MAC. If the agreement is not filed within the applicable period, the physician or supplier may need to wait until annual Open Enrollment to change participation status.

When a Participation Election Takes Effect

A participation agreement remains in effect through the calendar year and cannot ordinarily be revoked during that period. The agreement automatically renews for each subsequent calendar year unless the participating physician or supplier submits timely written notice during Open Enrollment to end participation.