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Medicare Opt-Out a Viable Physician Strategy

Greg Freeman, April 17, 2014

Opting out of Medicare has changed the face of Sapega and Sidor's practice, but the effects on their revenue and financial viability have been positive. They still see the occasional Medicare-eligible patient, and Sapega has performed a few surgeries on patients who paid out of pocket. But the situation can be even more promising for some specialties, Sapega says.

"If you opt out of Medicare and you're a surgeon, you pretty much won't see any Medicare patients. They will be sporadic at best," he says. "If you're an internal medicine doctor and you have a lot of loyal patients who can afford to pay your fee, that can be a different story. You may not lose so many of those Medicare patients."

Even so, an internal medicine or family practice physician can expect to lose perhaps 80% of his or her Medicare-eligible patients when opting out because those patients cannot afford the private pay, Sapega says. The impact on any practice will be significant, but losing 80% versus 95% might make a crucial difference for the practice's financial viability, he says.

Opting out can be the right move when a good portion of your patient population will continue seeking your care, Sapega says. "If not, opting out will simply reduce their practice revenue, and they may have to slow their practice down or change the practice structure to accommodate," he notes. "If you're in a situation in which Medicare is your primary payer, you would be crazy to drop out. It's not for everyone, but it's a serious option to consider."

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1 comments on "Medicare Opt-Out a Viable Physician Strategy"


Tibor Riley (4/17/2014 at 11:44 AM)
These two physicians are PEDIATRIC surgeons. Generally pediatricians don't deal with Medicare,which is mainly for the elderly. This is why pulling out of Medicare for them doesn't cause much problem. As for administrative requirements, I find the requirements from private insurance far more cumbersome. Medicare rarely denies claims; private insurance does frequently.