Opting out

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Opting out of Medicare is a right established by Secton 4507 of the Balanced Budget Amendment of 1997. It enables the following medical practitioners to leave the Medicare program entirely and treat patients pursuant to private contracts and free enterprise:

M.D.'s, D.O.'s, doctors of dental surgery or of dental medicine, podiatrists, optometrists, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, clinical psychologists and clinical social workers. Chiropractors are not (yet) allowed to opt out. Physical therapists and occupational therapists in independent practice cannot opt out either.

The regulations governing the procedures for opting are set forth here:


42 CFR § 405.405 General rules.
42 CFR § 405.410 Conditions for properly opting-out of Medicare.
42 CFR § 405.415 Requirements of the private contract.
42 CFR § 405.420 Requirements of the opt-out affidavit.
42 CFR § 405.425 Effects of opting-out of Medicare.
42 CFR § 405.430 Failure to properly opt-out.
42 CFR § 405.435 Failure to maintain opt-out.
42 CFR § 405.440 Emergency and urgent care services.
42 CFR § 405.445 Renewal and early termination of opt-out.
42 CFR § 405.450 Appeals.
42 CFR § 405.455 Application to Medicare+Choice contracts.

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