Should You Opt Out of Medicare? Pros and Cons

Leigh Page


November 13, 2018

In This Article

Con: Many Physicians Can't Do It

Opting out has a limited audience: It is rarely an option for employed physicians, and some group practices may not allow it. The audience is also shrinking, now that more and more doctors are employed.

In addition, La Penna says many other physicians should avoid opting out. His list includes:

  • Doctors in small practices who want to keep open the possibility of joining a large organization. "When you opt out, you're sealing yourself into a small, independent practice," La Penna says.

  • Some physicians with hospital privileges. Many hospitals require that on-call services must cover all patients, including those on Medicare, he says.

  • Physicians who are members of independent practice associations (IPAs) and physician-hospital organizations (PHOs). IPAs and PHOs usually require Medicare participation, La Penna says.

  • Physicians who want to moonlight in emergency departments or urgent care facilities, as a way of supplementing income as they build their new opted-out practices. La Penna says that these facilities want doctors who can bill Medicare.

Huntoon takes issue with some of these problems.

He agrees that employed physicians usually can't opt out, and their contracts may in fact bar them from doing so. But he says many physicians in groups have opted out, even when they're the only ones in the group to do so. He adds that sometimes a whole group opts out, such as Mayo Clinic.[11]

Huntoon concedes that emergency departments and urgent care facilities often don't accept opted-out physicians, but says there is no reason to do so. Medicare covers opted-out physicians whenever their patients have an emergent condition.

Also, opted-out physicians who want to supplement their income can work in prisons or take workers compensation cases, Moghadas says.


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