topic: Decide to Stay With or Opt Out of Medicare

As we mentioned during the previous step, while canceling your insurance contracts you’ll have to decide whether to stay with Medicare or if you’d like to opt-out of it altogether. There are merits to both options, but ultimately opting-out of Medicare completely and being financially buoyant should be your end goal.

Decide to Stay With or Opt Out of Medicare

Staying with Medicare

Staying with Medicare means you won’t be able to bill medicare patients directly.
While you’ll still be able to see and treat patients with Medicare, you won’t be able to charge them a monthly membership, and instead will have to claim back from Medicare for every treatment and patient visit.

Staying with medicare might make it easier to moonlight to support your new/growing practice. While this makes collecting payments quite tedious, it will allow you to see a greater number of patients and ensure you have enough revenue until you’re confident enough to finance your clinic with only DPC visits. Some may find it beneficial to maintain Medicare status at least until their clinic has a dedicated body of DPC patients.

Opting out of Medicare

Opting out of Medicare means you will be able to charge all patients a DPC membership fee and eschew a significant amount of unnecessary administration in order to collect payments.

You will also be able to maintain your ordering and prescribing status through Pecos.

The first step to opting-out is to copy the opt-out letter from the following address:

You’ll need to send your signed opt-out form at least 30 days before the “first day of the next calendar quarter showing the effective date of the calendar quarter.”

For example:

For a 01/01/2019 opt-out, send your letters at least by 12/01/2019
For a 04/01/2019 opt-out, send your letters at least by 03/01/2019

Next, notify all of your patients that you plan to opt out of Medicare. Make sure you do this more than once to ensure that every last patient is aware; the more times you make the announcement the better.

After your patients have been notified, copy the Medicare patient form from the following address:

When patients join your clinic, have them sign this form in order to document that they both understand that you as a practice have opted out of Medicare, and they can’t submit their bill to Medicare in order to claim reimbursement.

If you have any doubts about whether or not you should stay with Medicare, email our legal team with any questions and we’ll do our best to lay your concerns to rest.