Opportunity to Change Medicare Participation Status Starts Soon

Every fall, providers have a chance to reevaluate their Medicare participation status. If you do not get a notification from your Medicare administrative contractor (MAC) to confirm your participation status, and you want to make a change, contact your MAC or carrier to learn where to send the new agreement or changes.

During this period, you can choose among four options, depending on your current status:

1. Continue participation. Usually no action required, unless Medicare has asked you to revalidate. For most providers, this happens every five years.
2. Enroll as a provider (if you’re currently opting out entirely or have not previously participated).
3. Change participation status.
   1. From participating to nonparticipating: Submit a letter on provider letterhead, as detailed on our Medicare participation options page.
   2. From nonparticipating to participation: Submit the CMS-460 form (PDF).
4. Opt out of Medicare entirely:
   1. Submit an affidavit to Medicare, and
   2. Sign private contracts with all ongoing patients who are Medicare beneficiaries. For more on this, review our Medicare participation options page.

If you’re currently enrolled with Medicare, typically your administrative contractor will notify you when the period to change participation status begins. Once you receive this notification, you have 45 days or until Dec. 31 to decide if you want to continue or change your participation. Providers can also contact their MAC/carrier to learn where to send the agreement and get the exact dates for the open enrollment period when the agreement will be accepted.

COVID-19 Relief and Participation Options

If you received an advanced Medicare payment as part of COVID-19 relief, bear in mind that it could affect your ability to change your Medicare participation status for 2021. If you want to change your status and received one of these loans, contact your MAC for more details.