All licensed providers must consider Medicare

Since January 2024, licensed marriage and family therapists have been eligible to enroll as Medicare providers. If you are a licensed provider who has not yet decided what relationship you’ll have with Medicare, review this flow chart.

Opting out can have unintended consequences

Some providers who do not wish to participate in Medicare have chosen to opt out. Although opting out may be appropriate for some providers, it can have unintended consequences for patient assignments, network participation, employment relationships, contractual relationships, and future job opportunities. Health plans and healthcare delivery platforms may flag providers with Medicare opt-out statuses, change their patient assignments, or remove Medicare-ineligible providers from their networks. As businesses, they may require providers to serve all patient populations, including Medicare beneficiaries. If you are a licensed psychotherapist considering opting out of Medicare, CAMFT strongly recommends evaluating how that decision could affect your current and future professional relationships before submitting opt-out paperwork.

It might be time to renew your opt-out status

If you opted out of Medicare in 2024, you’ll be approaching your first opt-out renewal period in 2026. The opt-out auto-renewal cycle occurs every two years.

If you wish to remain opted out of Medicare, you do not need to take any action. If you’ve changed your mind and wish to enroll as a Medicare provider, you must notify your Medicare Administrative Contractor by letter no later than 30 days before the opt-out auto-renewal would occur. If you live and work in California, you’ll contact California’s MAC, Noridian Healthcare Solutions. You should begin the Medicare provider enrollment process within that 30-day timeframe as well.

If you’re uncertain about your opt-out status, visit the Centers for Medicare & Medicaid Services opt-out lookup to determine your opt-out renewal date. For more information about MFTs and Medicare, visit the Medicare Corner on CAMFT’s website.