Policy & oversight
Medicare Rights Center Warns That Proposals to Loosen Doctor Opt-Out Rules Could Raise Patient Costs
A new brief flags proposals circulating in Washington that would let doctors leave Medicare on a case-by-case basis, potentially leaving some patients responsible for their entire medical bill.
By the Goodsurance editorial teamNovember 13, 2026
Under a 1997 federal law, doctors may fully opt out of Medicare, allowing them to charge patients whatever they choose rather than the program's set rates. Patients who see opt-out providers receive no Medicare reimbursement and bear the entire cost of care. About 1.2 percent of non-pediatric physicians had taken this step as of recent data, according to KFF.
A November 12 brief from the Medicare Rights Center flags proposals that would significantly loosen those rules. Under current law, a physician who opts out must do so for all Medicare patients, not selectively. Proposals under debate would allow doctors to opt out on a patient-by-patient or service-by-service basis, letting them remain in the standard Medicare program for some patients while charging others unregulated amounts. Some versions would also allow Medicare to partially reimburse patients for services received from opt-out doctors, blurring the existing firewall between the two arrangements.
Proposals would let doctors leave Medicare one patient at a time. The Medicare Rights Center says that change could leave fixed-income beneficiaries facing unpredictable bills.
The Medicare Rights Center warns the change could create a two-tiered system. Beneficiaries with higher incomes or supplemental coverage might retain access to in-demand doctors, while those on fixed incomes could face unpredictable or unaffordable bills. The group urges Congress and CMS to preserve current opt-out restrictions as policymakers weigh physician payment reform, particularly following the November 5 midterm elections that shifted the balance of power in Congress.
Under existing rules, beneficiaries can verify a doctor's participation status before scheduling an appointment, providing a clear signal about expected costs.
In plain words
Right now, almost all doctors who see Medicare patients must follow Medicare's payment rules. A very small share, about one in every 100 doctors, has fully opted out. When you see an opted-out doctor, Medicare pays nothing and you owe the whole bill.
Some proposals would let doctors opt out for just one patient at a time, or for just one visit, instead of opting out for all their Medicare patients. The Medicare Rights Center says this would make it harder to know what a visit will cost before you go.
For people on fixed incomes, that uncertainty can be a serious barrier to getting care. The Medicare Rights Center is asking Congress and CMS to keep the current rules in place while physician payment is debated.
You can always check whether a doctor accepts Medicare before scheduling an appointment.
Understand the basics first
Source: Medicare Rights Center
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