No, therapists are not required to accept Medicare. You can choose to opt in and become a Medicare provider, opt out with private contracts, or not enroll at all.

Opting in means you complete Medicare enrollment and credentialing. You can then bill Medicare directly, and your clients can use their Medicare benefits to see you.

If you simply don’t enroll, you cannot accept private payment from Medicare clients for covered services. The only way to see Medicare clients as private pay is to formally opt out and use a private contract.

The pros include access to more clients, direct reimbursement, and professional credibility. The cons include lower reimbursement rates, strict documentation requirements, and a multi-year participation commitment.

Consider your client base, financial goals, and business model. If you want to expand access and serve Medicare beneficiaries, opting in may be best. If you prefer a boutique or private-pay model, opting out could be a better fit.