To opt out of Medicare, a dentist must file an affidavit (PDF)
with each applicable Medicare carrier and enter into written private contracts (PDF)
with patients who are Medicare beneficiaries. Opting out requires specific compliance requirements, including rules for documentation and deadlines, that must be understood prior to deciding whether or not to opt out.
Information about opting out of Medicare is available in Chapter 15, Section 40 (PDF) of the CMS Medicare Benefits Policy Manual. Information is also available on the CMS website Ordering & Certifying page. The ADA resource Opting Out of the Medicare Program contains a general discussion of the opt-out procedure. The Medicare Opt-Out FAQ answers some additional questions about opting out.
If a dentist opts out of Medicare, then a Medicare Advantage Plan may not reimburse the dentist or the patient, except for emergency or urgent care services. A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide the patient with all of his or her Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Some Medicare Advantage Plans also offer dental, vision, prescription drug coverage, and other coverage not covered by original Medicare.
NOTE: Medicare-eligible patients must be given notice that you’ve opted out of Medicare before covered services are delivered. This is accomplished by having the patient sign the Private Contract. ADA has made available a sample private contract (PDF).