Opt out affidavits submitted after June 16, 2015 will automatically renew every two years. If you submitted your affidavit prior to June 16, you must renew your status when the two years are up, but thereafter your status will automatically renew unless you notify Medicare otherwise. The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in April, which most notably eliminated the sustainable growth rate budget cap, also led to changes for physicians seeking to opt out of Medicare.