How to Opt Out of Medicare and Private Insurance

It is possible to open your practice while remaining opted-in to Medicare. Simply don't accept any Medicare-covered patients. Instead just take their contact info and reach out to them again when you are able to opt-out.

On the other side of the coin, it's possible to moonlight as an employed physician even after opting out, though only in limited circumstances. These include positions in occupational medicine, correctional medicine, addiction medicine, and urgent care. Hospice care is also possible, but only if your position is administrative in nature. These options are outlined in greater detail here.

Look up your state here to find a link to the proper opt-out affidavit and the address to mail it to.

You'll need to know some details of the opt-out process.

For participating providers in Medicare, new "batches" of Medicare opt-outs are made active on the first day of each calendar quarter (Jan 1, Apr 1, July 1, Oct 1). The Medicare carrier must receive your opt-out affidavit 30 days prior to the stated effective date (Dec 1, Mar 1, June 1, Sept 1, respectively). So if you start the opt-out process on December 2nd, the earliest you can be officially opted out is April 1. Plan accordingly.

If you are currently non-participating (NON-PAR), your opt-out will take effect immediately upon their receipt of your opt out form. If you are still employed or moonlighting, beware! You don't want to opt out with two months left before you quit.

Send the affidavit to the proper address (listed by state here). I recommend using a method with a guaranteed delivery date and proof of delivery (such as Certified Mail, return receipt requested).

If you wish, include a letter/prepaid envelope requesting that the carrier acknowledge in writing that the opt out was properly accomplished.

All new patients must sign an ABN to acknowledge that you are opted out of Medicare. English and Spanish forms are available for download here.

This may require that you dis-enroll as there is no “opt out” process with Medicaid. Some states may ask you to sign up as an ordering and referring only provider. For details on this process within your home state, Google "[state] Medicaid ordering and referring enrollment".

See the full DPC Frontier dicussion on Medicaid here.

Often this must be done 90 days out.

See a sample contract termination letter here. Notify all patients covered by that company that you are leaving their network (sample letter here).