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What does it mean if a physician has ‘opted out’ of Medicare?

This is mostly an issue for beneficiaries who have Original Medicare. Physicians and providers who have officially opted out of the Medicare program do not accept Medicare assignment (payment from Medicare) for any patient, no matter the situation. If and when they see Medicare beneficiaries, these physicians must establish a private contract with the individual and can charge whatever they wish. Because the physician or provider has opted out, Medicare (including Medicare Advantage and Medicare supplement plans) will not pay anything toward the service. The beneficiary is responsible for the entire bill and may have to pay it at the time the service or treatment is rendered. 

Physicians who have opted out of Medicare can also create payment issues for beneficiaries with a Medicare Advantage Private Fee-for-service (PFFS) or Medicare Cost Plan who get services outside the network, and those with a Medicare Advantage Medical Savings Account (MSA) plan. 

Last updated: 01-29-2016