What It Means When a Doctor "Opts Out" of Medicare
Every provider listed on AcceptsMedicare.com is enrolled in Medicare — but you may run into a doctor elsewhere who isn't, because they've formally "opted out." Here's what that means and why it's different from simply not accepting assignment.
Opting out is different from not accepting assignment
A doctor who doesn't accept assignment is still enrolled in Medicare and still bills Medicare — they just aren't required to take the Medicare-approved amount as full payment, so they can charge up to 15% more. A doctor who has opted out is a different situation entirely: they've chosen not to submit any claims to Medicare at all for a two-year period, for any Medicare patient. See how assignment works →
What a private contract means for you
To see an opted-out doctor for non-emergency care, you sign a private contract with them. Under that contract, you pay the doctor's full fee directly, and Medicare pays nothing toward the visit — not even the portion it would normally cover. There's no cap on what they can charge, since Medicare's fee schedule doesn't apply. The main exception is emergency or urgent care, which Medicare may still cover even from an opted-out provider.
How common is this?
Rare. Fewer than 1% of physicians in clinical practice have opted out of Medicare nationally, though the rate is somewhat higher in certain fields, particularly psychiatry, where private-pay practices are more common. For the vast majority of specialties and locations, you're very unlikely to run into an opted-out provider by accident.
Why you won't find opted-out doctors here
This directory is built entirely from CMS's Medicare enrollment file — the same records that confirm a clinician can bill Medicare. Since opted-out providers have removed themselves from that system, they simply don't appear in our data. If a provider you're considering isn't listed here, it doesn't necessarily mean they've opted out — ask them directly, since they may just not be Medicare-enrolled in the way this dataset counts, or may be new to practice since our last data refresh.
Frequently Asked Questions
What does it mean when a doctor opts out of Medicare?
It means they've chosen not to submit any claims to Medicare for two years and instead see Medicare patients only under a private contract, where you pay them directly and Medicare doesn't reimburse any of it.
Are opted-out doctors listed on this site?
No. This directory is built from CMS Medicare enrollment records, so it only includes clinicians currently enrolled in Medicare — opted-out doctors don't appear here.
How common is opting out?
Uncommon — fewer than 1% of physicians in clinical practice have opted out of Medicare, though the share is somewhat higher among certain specialties like psychiatry.
Does Medicare cover anything if I see an opted-out doctor?
Generally no, with a narrow exception for emergency or urgent care. Outside of that, you pay the opted-out provider directly under your private contract, and Medicare pays nothing toward that visit.
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Sources: CMS opt-out/private contracting regulations (42 CFR Part 405, Subpart D); Medicare Administrative Contractor opt-out guidance. This is directory and program information, not medical or insurance advice. Last reviewed August 2026.