In general, the majority of primary care doctors in the U.S. do accept Medicare. However, it’s always wise to verify coverage before your visit — especially when you’re seeing a specialist. You can do this by contacting the doctor’s office directly with your Medicare details or by reaching out to your Medicare plan provider for confirmation.
So, what’s the short answer? Yes — most doctors accept Medicare. In fact, about 93% of non-pediatric primary care physicians report accepting Medicare patients, which is comparable to the 94% acceptance rate for those with private insurance. Still, your specific Medicare plan and your status as a new or existing patient can influence access.
Keep reading to learn how to confirm whether a provider takes Medicare and how your type of coverage affects your options.
How to Locate Doctors Who Accept Medicare
Medicare makes it easy to find participating healthcare providers through its Physician Compare tool on the official Medicare website. This feature allows you to search for doctors, specialists, and healthcare facilities that are enrolled in the Medicare program.
You can also call 1-800-MEDICARE to speak with a representative for assistance.
If you have a Medicare Advantage plan, your insurance provider may offer a directory on their website or a customer service line you can use to search within your plan’s network.
Most tools allow you to search by:
-
Type of specialty or medical condition
-
Location or ZIP code
-
Provider gender
-
Hospital affiliation
-
Doctor’s last name
Regardless of the tool or method you use, it’s a good idea to contact the provider’s office directly to ensure they currently accept Medicare and are taking new patients.
Why Some Doctors May Decline Medicare
Not every doctor participates in Medicare. If a provider decides not to accept Medicare anymore, you can either pay for services out of pocket or look for another provider who does accept it.
Some doctors choose not to sign an agreement to accept Medicare’s approved payment rates. These providers are considered non-participating, meaning they’re enrolled in Medicare but can decide case-by-case whether to accept Medicare assignments — the pre-set amounts Medicare will reimburse for services.
What to Do If a Doctor Doesn’t Accept Medicare
Doctors who don’t fully participate in Medicare may charge more than the Medicare-approved amount. In these cases, you might be responsible for up to 15% more than the Medicare-approved rate, known as the limiting charge.
Some states have lower caps — for example, limiting the additional charge to just 5%. This extra amount is in addition to your standard 20% coinsurance.
Some providers may request payment upfront, while others will bill you later. Always check the provider’s payment policies before your appointment so you’re not caught off guard.
If you pay out of pocket, you typically have up to one year to submit a claim to Medicare for possible reimbursement.
Final Thoughts
While most physicians — especially those in primary care — accept Medicare, it’s best not to assume. Always double-check that your doctor participates in the Medicare program and is accepting new Medicare patients. If your current provider opts out of Medicare, ask how it might affect your care and what your options are moving forward to avoid unexpected costs.