Question and Answer

Can I submit claims to Medicare if my doctor opted out?

Question: 
My doctor decided to opt out of Medicare. He told me that Medicare will not pay for his services and he is not subject to Medicare laws and rules. Can I submit a claim to Medicare for the care I get from him?

Answer:
No. If you signed an agreement to receive care from a doctor who has opted out of Medicare, you cannot submit a bill to Medicare and must pay the bill yourself. In addition, doctors who have opted out of Medicare can charge you as much as they want.

The only time that Medicare will cover your care from a doctor who has opted out is when:

  1. The doctor provides you with emergency or urgent care services; or

  2. The doctor did not give you a written contract to sign before you received the services.
To avoid having to pay in full for doctor services, you should switch to a doctor who accepts Medicare. To pay the least, it's best to make sure that doctor also accepts assignment (accepts Medicare's approved amount as full payment for services).

return to referring page