The words "opt-out" are often seen in the context of United States Medicare. Naturally, since this is a government program, the words mean three very different things. The Medicare bureaucracy and the goo goos in academia and government who are "here to help" try to do everything they can to confuse taxpayers so you will feel dependent on them.
The good or at least most common meaning of opt out in Medicare refers to providers, mostly doctors. A very low percentage of doctors who had initially signed up to "accept assignment" of patients with Medicare when they left medical school then later opt out. Non-participating physicians also drop out (a future post will explain the difference between participating -- accepting assignment -- and non participating). An increasing number of providers are doing this for philosophical reasons (see the United States Medicare death panel debate) but the most common reason is business; United States Medicare fee for service rates are well below market levels.
The bad or at least very uncommon meaning of the term opt out in relation to United States Medicare refers to an eligible senior choosing not to join Original Medicare. Again this is typically for some kind of survivalist philosophical reason but sometimes not joining also makes financial sense. You can opt out if you want but it also typically means you cannot collect Social Security. (I might post about this sometime but the whole discussion is beyond weird and applies to very few people even when legitimate.)
The ugly meaning of the term opt out in the context of United States Medicare is what prompts me to write this post. Opt out has been used by opponents of the public Part C Medicare Advantage health plan program. Sometimes it's looney lefties using the term this way but most often I see "opt out" in context of skilled nursing facility (SNF) benefits and I have seen and heard it often from SNF managers. I cannot confirm with data that this is a common SNF business practice but I would not be surprised. For example, it is not accurate to write (as this SNF executive did recently):
"Enrollment in (public Part C) plans means the individual is opting out of original Medicare."
No one on Original Medicare opts out of it. As the SNF propaganda article from which the quote was taken says right above this sentence, a person on Medicare cannot have a public Part C plan without first signing up for Original Medicare Parts A and B. Everyone on Medicare is in Original Medicare. That includes (see image) the very few just on Part A (2% or so), or just Part B (less than a percent), or A and B and retiree insurance (around 35%; some retiree insurance may not require B and some pay for B), or A and B and Part C (the roughly 30% on Medicare Advantage or other C supplements), or A and B with a private Medigap plan usually with a standalone Part D self-administered drug plan (around 20%), or those with A plus "free" or almost free B and Medicaid (15%).
You could say people who choose Part C are "opting out" of traditional fee for service Medicare by choosing a public Part C managed-care health plan. But the better way of expressing the choice is managed, highly networked insurance (make sure your doctor accepts) vs. unmanaged, totally free-to-choose insurance (especially important to snow birds). This is not much different than the choice most of us who received insurance through an employer our whole working lives have been making for 30 years.
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