Opt Out of Medicare

Instructions to File

The requirements to opting out of Medicare are included on the forms.

  • First, at least one private contracting agreement form must be signed between the physician or practitioner and a beneficiary.
  • Second, the physician or practitioner will be required to submit an affidavit form within ten days after entering into the first private contract to which the affidavit applies.

Note: Opt-out does not require a physician or practitioner to initially enroll with Medicare or complete a CMS-855I application.

Form(s) you'll need:

Medicare Opt-Out Affidavit
Medicare Private Contract Form