How Opt-Out Affects Medicare Beneficiaries

When a provider opts out of Medicare:

  • Beneficiaries agree to pay the provider directly for all services covered by the private contract.
  • Medicare does not reimburse any portion of the charges.
  • Medicare fee limits do not apply to the provider's charges.
  • Beneficiaries may choose to receive care from Medicare-enrolled providers instead.

These terms must be documented in a private contract between the provider and each Medicare beneficiary.

Last Updated May 28 , 2026