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Medicare Opt-Out Affidavit and Instructions

Office Essential

What is it?
A sworn statement declaring your intent to operate outside of the Medicare program.
Includes separate instructions on the procedure to actually opt-out properly.

Why do I need it?
Providers opt out of Medicare for a variety of reasons. Most opt out because they do not want to be subject to Medicare limits on what they can charge for their services. It is similar to a cash-based practice that operates outside of the insurance networks.

When do I use it?
Depends on the provider’s current status. Participating providers can opt-out only at the beginning of a calendar quarter. Non-participating providers may opt out at any time.

Who is it for?
All providers looking to ensure they properly opt out of Medicare.