Most primary care physicians do accept Medicare.
However, it’s always wise to verify your coverage before your visit — especially when scheduling with a specialist. You can do this by calling the doctor’s office and sharing your Medicare information or by contacting your Medicare provider directly.

In short, the answer is yes. Around 93% of non-pediatric primary care doctors report accepting Medicare, which is nearly the same as the 94% who take private insurance. Still, acceptance can depend on the specific type of Medicare plan you have and whether you’re already an established patient.

Keep reading to learn more about Medicare coverage and how to confirm if you’re covered.

How to Locate a Doctor Who Accepts Medicare

The official Medicare website offers a helpful search tool called Physician Compare, which lets you find doctors and healthcare facilities that participate in Medicare. You can also speak directly with a representative by calling 800-MEDICARE.

If you have a Medicare Advantage plan, you can search for in-network doctors by contacting your plan provider or logging into their member website.

These resources usually allow you to search by:

• Specialty or medical condition

• Body system or organ

• Location or ZIP code

• Doctor’s name

• Gender

• Hospital affiliation

Even after using these tools, it’s always smart to call the doctor’s office directly to confirm that they accept Medicare and are currently taking new Medicare patients.

Why Some Physicians Decline Medicare

Some doctors may choose not to accept Medicare for a variety of reasons. If your physician stops taking Medicare, you can either continue seeing them by paying out of pocket or switch to a provider who does accept it.

If a doctor hasn’t signed a full agreement to accept assignment (the approved Medicare payment amount for services), they are considered a non-participating provider. These providers can decide on a case-by-case basis whether to accept Medicare’s approved amount.

What to Do If a Doctor Doesn’t Accept Medicare

Doctors who participate fully in Medicare cannot charge you more than the Medicare-approved rate. Non-participating providers, however, may charge up to 15% more than that rate. Some states cap this “limiting charge” at 5%, in addition to your standard 20% coinsurance.

Depending on the office policy, you might need to pay these charges at the time of your appointment, or you might receive a bill afterward. Always confirm the payment process before your visit to avoid surprises.

If you pay out of pocket, you have up to one year to file a claim with Medicare for possible reimbursement.

The Bottom Line

The majority of healthcare providers accept Medicare, but it’s always best to double-check before your appointment. If your doctor ever decides to stop accepting Medicare, ask how this change affects your coverage and what options are available to ensure you remain financially protected.