Should You Opt Out of Medicare? Pros and Cons

Leigh Page


November 13, 2018

In This Article

Four Reasons You May Want to Stay in Medicare

One of the biggest hurdles of opting out is convincing your Medicare patients to give up Medicare coverage and pay you out-of-pocket.

"Patients on fixed incomes are scared of losing Medicare," La Penna says. "The patient is thinking, 'I had to live a long time to get Medicare coverage, and I don't want to give it up.'"

Con: Your Medicare Patients May Walk Away

Huntoon says that in many cases, opted-out physicians retain almost all of their Medicare patients, but La Penna tells doctors contemplating the change that they should expect to lose half of their patients, and Zetter asserts the conversion rate is more like 1%.

Before opting out, Medicare requires physicians to poll their patients and sign agreements with those who decide to stay with the opted-out physician. However, many of these patients cut back on visits or drop out of the practice altogether, according to Katherine A. Roberts, MD, a Virginia-based endocrinologist. She opted out of Medicare for 6 years, then rejoined in July 2016.

"People who say that they will pay you will decrease their visits or change providers once faced with the facts," Roberts said in a 2016 interview. "When it comes down to it, people are just not thrilled about spending money when they are already paying for insurance."[10]

La Penna thinks opting out works best if you have a lot of well-to-do patients. He cites high-income communities, such as Boca Raton, Florida; Telluride, Colorado; and Manhattan in New York City.

Huntoon's experience, however, contradicts this scenario. He opted out near Buffalo, New York—not a high-income metropolitan area. He did not solicit patients when he opted out, because he started his opted-out practice at a new location, but he has managed to maintain a busy practice.

Make Care Affordable for Your Patients

He says the key to success is to charge affordable fees, which is possible because expenses are lower—particularly if you have dropped out of all insurances and no longer have a billing function.

Huntoon says his fees for an office visit are $100 for first-time patient and $40 for an established patient. "If you charge too much, you're going to find that the market pushes back," he says. He adds that he also offers longer visits than other physicians, which patients see as an added value.

In addition, patients of opted-out physicians can still receive Medicare coverage for other services not provided by the opted-out physicians, including specialists, ancillary services, and hospitalizations.


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