Grand Junction and Mesa County · Your doctor and Medicare
What If My Grand Junction Doctor Opts Out of Medicare?
It usually arrives as a letter from the clinic, or a form at check-in: "Dr. So-and-so has opted out of Medicare. To continue care, please sign the attached agreement." People bring that letter to me and ask two things. Is my Medicare still good? And does my supplement cover this now? Here is the honest answer, and how many Mesa County clinicians it applies to today.
The short answer
- Your Medicare is fine. It just won't pay that one clinician, outside emergencies.
- Your Medigap or Advantage plan won't pay them either. Neither can step in where Medicare doesn't pay.
- To keep seeing them, you sign a private contract and pay whatever they charge. Medicare's price limits don't apply.
- Labs, imaging and prescriptions they order are usually still covered when another provider does the work.
- It's rare here: 28 clinicians in Mesa County had an active opt-out on CMS's list on October 24, 2026.
Opting out isn't the same as "not taking new Medicare patients"
The two get mixed up all the time. A practice that is full or "not taking new Medicare patients" still bills Medicare for the patients it has. A clinician who has opted out has filed a sworn affidavit with Medicare saying they won't bill it for anyone. Medicare.gov puts it plainly: "Medicare won't pay for items or services you get from provider that opts out, except in emergencies."
The decision lasts at least two years. Medicare.gov: "Every 2 years, the provider can choose to keep their opt-out status, accept Medicare-approved amounts on a case-by-case basis ('non-participating'), or accept assignment." In practice most stay out, and the opt-out renews unless they cancel it. Many of these clinicians run membership or cash-pay practices. Our post on concierge medicine and Medicare explains how those fees work. Not every concierge doctor has opted out, though, and not every opted-out doctor runs a concierge practice.
How many clinicians in Mesa County have opted out?
CMS publishes every active affidavit in its opt-out data file. I pulled it on October 24, 2026. Colorado has 1,284 active opt-outs. Mesa County has 28: 27 in Grand Junction and one in Fruita.
| Type of clinician (Mesa County) | Active opt-outs |
|---|---|
| Family practice doctors | 7 |
| Physician assistants and nurse practitioners | 7 |
| Counselors, social workers and a psychiatrist | 5 |
| Foot, dental and oral surgery | 5 |
| Other specialists (GI, sports medicine, preventive medicine, plastic surgery) | 4 |
Source: CMS Opt Out Affidavits file, pulled October 24, 2026, counting affidavits whose opt-out period ends on or after that date. The file lists individual clinicians, not clinics, so one practice can have some clinicians in and some out.
For context, CMS counted 41,761 people on Medicare in Mesa County in July 2026. Twenty-eight clinicians is a small number. But seven are family doctors, and when your family doctor is the one who leaves, it doesn't feel small. Elsewhere on the Western Slope, Montrose has 11 active opt-outs, Cortez and Glenwood Springs have 5 each, and Delta has none.
The dentists and oral surgeons on the list matter less than they look. Original Medicare covers almost no routine dental care in the first place. Our dental, vision and hearing post covers what it does pay for.
What the private contract has to say
An opted-out clinician can't treat you for a Medicare-covered service without a written contract, signed before the visit. 42 CFR § 405.415 spells out what it must contain. Read it for these lines:
- You "accept full responsibility for payment" of the clinician's charges.
- "Medicare limits do not apply" to what they can charge. The 15% cap on what non-participating doctors can bill doesn't apply to an opted-out doctor.
- You agree not to submit a claim to Medicare, and they won't either.
- "Medigap plans do not, and that other supplemental plans may elect not to, make payments" for these services.
- You have "the right to obtain Medicare-covered items and services from physicians and practitioners who have not opted-out."
- The start and end dates of the clinician's current two-year opt-out period. A new contract is needed for each period.
The contract can't be signed while you need emergency or urgent care, and you get a copy before treatment. If an office asks you to sign one on the exam table with chest pain, that isn't how the rules work.
Got an opt-out letter from your doctor?
Bring it to a free review. We'll look at what you'd pay out of pocket to stay, and at Grand Junction clinicians who take Medicare and the plans we offer, before you sign anything. Open Enrollment runs October 15 to December 7. Free, by phone or in our Grand Junction office.
Book a free review →Who pays for what once your doctor is out
The opt-out applies to that clinician's own services. It doesn't cancel the rest of your Medicare. This table shows how the common bills land:
| The bill | Medicare | Medigap or Advantage plan | You |
|---|---|---|---|
| The office visit with the opted-out doctor | Nothing | Nothing. Medigap and Advantage plans can't pay either | The full price in the private contract |
| Blood work or an MRI that doctor orders, done at a lab or hospital that takes Medicare | Usually covered, if the doctor is eligible to order | Your normal coverage applies | Your normal share |
| A prescription that doctor writes | Your Part D plan can cover it | Drug plan rules apply | Your normal copay |
| Emergency or urgent care from an opted-out doctor you never signed with | Covered; the doctor must bill Medicare | Your normal coverage applies | No more than Medicare's limits |
Sources: 42 CFR §§ 405.415, 405.425(a) and (i), and 405.440; Medicare.gov's provider-payment page.
The second row surprises people. 42 CFR § 405.425(i) lets an opted-out clinician who hasn't been excluded from Medicare "order, certify the need for, prescribe, or refer" you for covered services and drugs. So the visit is cash, but the bloodwork at the hospital lab, the CT scan and the prescription at your pharmacy normally go through your coverage. CMS's file flags who is eligible to order and refer, and in Mesa County 21 of the 28 are. If you're on an Advantage plan, the lab or imaging center still has to be one your plan covers, and the plan may need a referral or prior approval.
The emergency row comes from 42 CFR § 405.440. If an opted-out doctor treats you in an emergency and you never signed a contract with them, they must bill Medicare and can't charge you more than Medicare's limits.
Your three choices
- Stay and pay cash. Ask for the fee schedule in writing. Some practices charge per visit, some charge a yearly membership, some both. Keep your Medicare and supplement for everything else: hospitals, specialists, labs and drugs.
- Move your care. Ask the office whether another clinician in the same practice still bills Medicare, since opt-outs are filed one person at a time. If you're on an Advantage plan, check the new doctor against your plan's directory. Our post on checking a doctor against a 2027 network walks through it.
- Do both for a while. Some people keep a cash-pay doctor for continuity and also establish care with a clinician who bills Medicare, so referrals and paperwork go through someone who takes it.
One thing not to do is drop your Medigap plan because a single doctor left Medicare. Your supplement still covers every other Medicare bill, and in Colorado getting a Medigap plan back later can mean answering health questions.
How to check a doctor before you need them
Medicare.gov links to CMS's opt-out look-up tool. Search a last name and it shows the specialty, the city and the dates of the current opt-out period. It's worth thirty seconds before you choose a new primary care doctor or accept a referral. For clinicians who do bill Medicare, the next question is whether they accept assignment. Our Plan G vs. Plan N post for Colorado explains why that matters for your supplement.
I have spent more than 22 years helping people with Medicare, and an opt-out letter is one of the few times a doctor's decision changes your bill without changing your coverage. Read the contract, ask what it costs, and decide with the numbers in front of you.
How we know all this: the Medicare On Main Data Desk frames every article with public data. Here that means Medicare.gov's page on whether a provider accepts Medicare as full payment; CMS's Opt Out Affidavits data file, pulled and counted October 24, 2026; 42 CFR §§ 405.415, 405.425 and 405.440; and CMS's Medicare Monthly Enrollment data for Mesa County, July 2026. The opt-out counts are affidavits on file that day; they change as clinicians opt in or out. No clinician is named here, and nothing here is a judgment of any practice. Medicare On Main is not affiliated with any provider mentioned. This is education, not advice. Confirm a clinician's status with the office or Medicare.gov, and compare plans with a licensed agent. We take no payment from any carrier to feature a plan.
Frequently asked questions
What happens if my doctor opts out of Medicare?
Medicare stops paying for anything that doctor does for you, outside emergencies. Medicare.gov says "Medicare won't pay for any service you get from this doctor, even if it's a Medicare-covered service." To keep seeing them, you sign a private contract and pay their price. You can also move your care to a clinician who takes Medicare, and your coverage works there as usual.
Will my Medigap plan pay a doctor who opted out of Medicare?
No. Federal rules require the private contract to say that "Medigap plans do not, and that other supplemental plans may elect not to, make payments" for services Medicare didn't pay for. A Medigap plan only pays its share after Medicare pays, so with no Medicare payment there is nothing for Plan G or Plan N to add to.
Can I see a doctor who opted out of Medicare if I have Medicare Advantage?
You can see them, but your plan won't pay. Under 42 CFR § 405.425, during the opt-out period no payment may be made "directly by Medicare or by any Medicare Advantage plan" to that clinician. You would pay out of pocket under a private contract, just as someone on Original Medicare would.
How do I find out if my doctor opted out of Medicare?
Search the doctor's name in CMS's opt-out look-up tool on data.cms.gov, which Medicare.gov links to. It shows the specialty, the city, and the start and end dates of the current two-year opt-out period. Then confirm with the office. A doctor who opted out has to give you a written contract before treating you, so you shouldn't be surprised by it at the front desk.
Does Medicare cover lab work ordered by a doctor who opted out?
Usually, yes. 42 CFR § 405.425(i) lets an opted-out clinician who hasn't been excluded from Medicare "order, certify the need for, prescribe, or refer" you for Medicare-covered services and drugs. The lab, imaging center or pharmacy then bills Medicare or your plan in the normal way. CMS's opt-out file shows whether each clinician is eligible to order and refer. In Mesa County, 21 of 28 are.
Sources
- Medicare.gov — Does your provider accept Medicare as full payment?: Medicare doesn't pay opted-out providers, the two-year minimum and private contracts.
- CMS — Opt Out Affidavits data file (data.cms.gov): 1,284 active Colorado opt-outs; 28 in Mesa County.
- CMS — Provider Opt-Out Affidavits Look-Up Tool (data.cms.gov): look up any clinician by name.
- 42 CFR § 405.415 — Requirements of the private contract (Cornell LII): what the contract must say, including the Medigap line.
- 42 CFR § 405.425 — Effects of opting out of Medicare (Cornell LII): no Medicare or Advantage plan payment; ordering and prescribing.
- 42 CFR § 405.440 — Emergency and urgent care services (Cornell LII): emergency and urgent care billing.
- CMS — Medicare Monthly Enrollment, Mesa County, Colorado, July 2026 (data.cms.gov): 41,761 Medicare beneficiaries in Mesa County.
