Home / For providers / Medicare opt-out
Federal rule - not a consultant version
Medicare opt-out for a cash-pay practice
Cash-pay hormone clinics keep hitting the same fork: enroll in Medicare, formally opt out, or do not see Medicare patients. This is the CMS version of that fork.
Key facts
- If you see Medicare patients and you do not want to enroll, CMS says you must opt out: file an affidavit and sign a private contract with each Medicare patient.
- If you do not see Medicare patients, CMS says you do not have to enroll or opt out.
- You cannot opt out for some Medicare patients or some covered services and stay in for others. Emergency and urgent care have separate limits.
- An opt-out period is two years and auto-renews unless you cancel in writing with your MAC at least 30 days before it expires.
- CMS publishes a public opt-out dataset. This is not a quiet private election.
What opt-out means
You and the patient cannot bill Medicare for those services. The patient pays out of pocket. You may still be able to order and certify Medicare items for those patients. Withdrawing because you retired is a different process.
What you file
Eligible type or specialty, an opt-out affidavit to Medicare, and a private contract with each Medicare patient. CMS does not publish one national form. You get the affidavit from your MAC. Multiple MAC jurisdictions means multiple affidavits.
When the clock starts
Never enrolled or non-participating: the day you sign. Participating: first day of the next calendar quarter, and only if the affidavit was in at least 30 days prior. You can terminate an initial opt-out in the first 90 days. After auto-renew, you cannot terminate early.
Who may / may not
Physicians and many NPPs (including PAs and NPs) may opt out. Chiropractors, PTs, OTs, anesthesiology assistants, audiologists, and SLPs may not. NP- or PA-led hormone clinics: eligibility is not the same question as state scope. Check both.
Questions
Can I stay in Medicare for older patients and cash-pay everyone else?
Not as an opt-out. CMS says you cannot choose some Medicare patients or some covered services. Enroll, opt out for all covered services, or do not treat Medicare patients.
Is Medicare Advantage a workaround?
CMS states MA plans may not pay, directly or indirectly, for basic services an opted-out physician or practitioner provides to a Medicare enrollee. Urgent or emergency care has a separate rule when there is no private contract.
Where do I get the form?
From your MAC, not from this site. CMS's manage-enrollment page is the index.
Not legal advice, not a completed affidavit, and not a recommendation to opt out. Some cash-pay practices never see Medicare patients and never file.
One call. Real numbers. No pressure.
Call/text: (817) 583-1874 - Email: chris@marketmedical.io