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Physicians and practitioners who do not wish to enroll in the Medicare program may “opt-out” of Medicare. This means that neither the physician, nor the beneficiary submits the bill to Medicare for services rendered. Instead, the beneficiary pays the physician out-of-pocket and neither party is reimbursed by Medicare. A private contract is signed between the physician and the beneficiary that states, that neither one can receive payment from Medicare for the services that were performed. While this might seem like a drawback for patients reliant on Medicare, there can be several key benefits for patients in this arrangement:

More Personalized Care
Providers who opt out of Medicare often have more flexibility in the care they offer and the amount of time they can spend with each patient. Since they're not bound by Medicare's strict reimbursement rules and time constraints, doctors may be able to provide more thorough, individualized care, spending more time with patients during each visit.

Expanded Treatment Options
Providers who opt out are not restricted by Medicare’s guidelines on which treatments and services they can offer. This can lead to a broader range of treatment options, including alternative or holistic therapies that Medicare might not cover.

More Transparent Pricing
Patients know upfront what the costs of services will be, and providers usually offer clear, transparent pricing. There can be fewer hidden fees or complex billing situations, giving patients better control over their healthcare expenses. In some cases, patients may even negotiate lower fees directly with their provider.

Improved Access to Specialized Care
Patients may have better access to highly specialized providers who have opted out of Medicare to focus on niche practices, concierge medicine, or specialized treatments.
This can be particularly important for patients with complex, chronic conditions that require a more personalized, hands-on approach to care, which may not be feasible under Medicare’s reimbursement structure.

Avoiding Medicare Red Tape
Opting out means providers are not bound by Medicare's extensive paperwork, regulations, and limitations. This frees up administrative time for the provider, allowing them to focus more on patient care and reduce the administrative burden that can slow down or limit access to services under Medicare.

Fewer Limitations on Doctor-Patient Relationships
Without Medicare’s regulations, doctors can form more direct, unregulated relationships with their patients, offering more continuous, consistent care. Patients can develop stronger, longer-term relationships with their providers, enhancing trust and communication, which are vital for effective treatment and management of health conditions.

Reduced Wait Times and Better Scheduling
Providers who opt out of Medicare typically have fewer patients, as they don’t rely on high patient volumes to meet Medicare’s reimbursement demands. Patients often experience shorter wait times for appointments, more flexible scheduling, and a less rushed experience during visits, improving overall care quality.

Potential Access to Concierge Medicine

Many providers who opt out of Medicare offer concierge medicine, where patients pay an annual fee for enhanced services, such as same-day appointments, direct communication with the doctor, and preventive health planning. Concierge medicine can offer a higher level of care with greater focus on prevention and long-term health outcomes, which can be particularly valuable for managing chronic conditions.

Freedom to Choose Non-Covered Services
Medicare may not cover certain tests, treatments, or preventative services that patients may want or need. Opted-out providers can offer these without restriction. Patients have the freedom to pursue care outside of the limitations imposed by Medicare, which can be particularly important for innovative treatments or personalized healthcare approaches that Medicare doesn’t cover.

Flexibility in Payment Arrangements
Some providers who opt out of Medicare may offer more flexible payment options, including installment plans, discounts for prompt payments, or sliding-scale fees. This flexibility can make high-quality care more affordable and accessible for patients who may otherwise struggle with Medicare’s co-pays and deductibles.

Functional Medicine is not just for the wealthy. Most of our patients are working and middle class people who want to get healthy and feel great. Our top patient base profession wise are actually nurses and school teachers who want to get healthy. We want to take on patients we believe we can improve their overall health. Price depends on several factors including the extent of lab testing required, the combination of natural medicines and other protocols needed, and the number of webcam you receive. We offer flexible care plans as well as concierge functional medicine plans. We do everything we can to make Functional Medicine affordable to the average person around the world. Please see the consultation page for more detailed cost information.