Medicare Opt-Out FAQ | American Dental Association

Medicare Opt-Out FAQ

How long does an opt-out last?

No. The affidavit that you must sign in order to opt out must state that, during the opt-out period, you understand that you may receive no direct or indirect Medicare payment for services that you furnish to Medicare beneficiaries with whom you have privately contracted, whether as an individual, an employee of an organization, a partner in a partnership, under a reassignment of benefits, or as payment for a service furnished to a Medicare beneficiary under a Medicare Advantage plan.

If I opt out of Medicare, can I continue to receive payment for services to Medicare beneficiaries under a Medicare Advantage plan?

Once you file an affidavit notifying the Medicare carrier that you have opted out of Medicare, you are out of Medicare for two years from the date the affidavit is signed, unless you terminate the opt-out early under §40.35 of the Medicare Benefit Policy Manual (PDF), or unless you fail to maintain opt-out (see §40.11 of the Medicare Benefit Policy Manual [PDF]). Opt-out affidavits signed on or after June 16, 2015, will automatically renew every 2 years. If a dentist who files a valid affidavit effective on or after June 16, 2015, does not want the opt-out to automatically renew at the end of a two year opt-out period, the dentist may cancel the renewal by notifying all Medicare Administrative Contractors (MACs) with which the dentist filed an affidavit in writing at least 30 days prior to the start of the next opt-out period. Valid opt-out affidavits signed before June 16, 2015 will expire 2 years after the effective date of the opt out. If a dentist who filed an affidavit effective before June 16, 2015, want to extend the opt out, the dentist must submit a renewal affidavit within 30 days after the current opt-out period expires to all MACs with which the dentist would have filed claims absent the opt-out.

If I opt out and change my mind, can I terminate the opt-out?

Maybe. Under §40.35 of the Medicare Benefit Policy Manual (PDF), if you change your mind after the carrier has approved your opt-out affidavit, the opt-out may be terminated within 90 days of the effective date of the affidavit. To properly terminate an opt-out, you must:

  • Not have previously opted out of Medicare;
  • Notify all Medicare carriers, with which you filed an affidavit of the termination of the opt-out no later than 90 days after the effective date of the opt-out period;
  • Refund to each beneficiary with whom you have privately contracted all payment collected in excess of:
    • The Medicare limiting charge (in the case of physicians or practitioners); or
    • The deductible and coinsurance (in the case of practitioners).
  • Notify all beneficiaries with whom you entered into private contracts of your decision to terminate opt out and of the beneficiaries' rights to have claims filed on their behalf with Medicare for services furnished during the period between the effective date of the opt-out and the effective date of the termination of the opt-out period.

If you were previously enrolled in Medicare, when you properly terminate opt-out in accordance with the second bullet above you will be reinstated in Medicare as if there had been no opt-out.