How to opt out of Medicare

Look up your state, fill out the linked affidavit, and send it to the listed address
AL, GA, TN
Affidavit
Cahaba GBA, LLC
Provider Enrollment - Part B
P.O. Box 6169
Indianapolis, IN 46206-6168

AK, AZ, CA, HI, ID, MT, NV, ND, OR, SD, UT, WA, WY, Samoa, Guam, Northern Mariana Islands
Affidavit
Noridian Healthcare Solutions
Provider Enrollment
P.O. Box 6703
Fargo, ND 58108-6703

AK, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX, VA (Arlington and Fairfax, plus Alexandria)
Affidavit
Novitas Solutions
JH Provider Enrollment Services
P.O. Box 3095
Mechanicsburg, PA 17055-1813

CT, IL, ME, MA, MN, NH, NY, RI, VM, WI
Affidavit
National Government Services, Inc.
Part B Provider Enrollment
P.O. Box 7149
Indianapolis, IN 46207-7149

FL, Puerto Rico, US Virgin Islands
Affidavit
First Coast Service Options
Provider Enrollment
P.O. Box 44021
Jacksonville, FL 32231-4021

NC, SC, VA (excl. Arlington and Fairfax counties, and Alexandria), WV
Affidavit
Palmetto GBA
Part B Provider Enrollment (AG-310)
P.O.Box 100190
Columbia, SC 29202-3190

IN, IA, KS, MI, MO, NE
Affidavit
Wisconsin Physicians Service
Provider Enrollment
P.O.Box 8248
Madison, WI 53708-8248

OH, KY
Affidavit
CGS Administrators LLC
J15 - Part B Provider Enrollment
PO Box 20017
Nashville, TN 37202