Short answer: When a doctor opts out of Medicare, Medicare will not pay for the services you get from that doctor, except in emergencies. You usually sign a private contract and pay the doctor yourself. An opt-out lasts at least two years. Before you sign, Medicare.gov suggests contacting your State Health Insurance Assistance Program.
Some doctors choose not to work with Medicare at all. Medicare.gov says Medicare will not pay for items or services you get from a provider who opts out, except in emergencies. That is true even for a service that Medicare would normally cover. A doctor who has opted out cannot send claims to Medicare for your visits.
A private contract is a written agreement between you and the doctor. Medicare.gov says you may need to pay upfront or set up a payment plan with the provider through this contract. An article from the American Academy of Family Physicians says the contract must be in writing, in type that you can read, and signed by both sides. It must say that you accept full responsibility for paying the doctor's charges, and it must give the dates the opt-out starts and ends. The doctor must give you a copy before providing services.
Medicare still pays for emergency care, as the Medicare.gov page above says. The AAFP article explains that an opted-out doctor can give emergency or urgent care to a Medicare patient who has not signed a private contract and bill Medicare for it, without losing opt-out status, when Medicare billing rules are followed. Ask the practice how it handles urgent and emergency visits. Medicare.gov also says Medicare does not cover concierge membership fees, which is a separate cost from opting out.
Medicare.gov says providers opt out for a minimum of two years. After each two-year period, a doctor can keep opting out or can go back to working with Medicare. The AAFP article adds that the opt-out renews on its own every two years unless the doctor asks to end it.
Medicare.gov suggests contacting your State Health Insurance Assistance Program, often called SHIP, before signing a private contract.
You can read about what concierge medicine is or find a direct-pay doctor near you. For an emergency, call 911.
Medicare.gov says it will not pay for items or services from a provider who opts out, except in emergencies.
Medicare.gov says providers opt out for a minimum of two years. The AAFP article says it renews every two years unless the doctor asks to end it.
Medicare.gov suggests contacting your State Health Insurance Assistance Program (SHIP) before you sign.
