Opt Out of Medicare - JF Part B
Opt Out of Medicare
Opting out of Medicare means a physician or practitioner will not submit claims to Medicare for items or services furnished to Medicare beneficiaries (except for certain emergency or urgent care services). During the opt-out period, Medicare will not pay the physician or practitioner (directly or indirectly) for those items or services, and the beneficiary pays the physician or practitioner directly under a private contract.
Opting out is only available to certain individual physicians and practitioners. Clinics, groups, and other organizations cannot opt out. If a provider opts out, the provider must enter a private contract with each Medicare beneficiary before furnishing non-emergency services.
Opt-out applies to all Medicare programs nationwide, including Original Medicare and Medicare Advantage. A provider cannot opt out for only certain services, locations, or Medicare programs while participating in others.
To opt out, the provider must sign a compliant private contract with each Medicare beneficiary before providing non-emergency services. Under the contract, the beneficiary agrees not to seek Medicare reimbursement, and Medicare will not reimburse either the provider or the beneficiary for those services, even if a claim is later requested.
Opting out is different from Medicare "participating" and "non-participating" status. When a provider opts out, the provider cannot submit Medicare claims or accept Medicare payment for services covered by a private contract.
Some providers choose to opt out because they do not want to follow Medicare billing requirements or accept Medicare payment amounts. If a provider wants Medicare to pay for services, opting out is not the appropriate option.
Each opt-out period lasts two years and automatically renews unless the provider cancels on time. While opted out, the provider must use compliant private contracts with Medicare beneficiaries, and only certain individual provider types are eligible to opt out.
