What Percentage of Doctors Accept Medicare?

Medicare is a federal health insurance program primarily designed for individuals aged 65 or older, along with certain younger people with disabilities and those with End-Stage Renal Disease. A common question among beneficiaries and those approaching Medicare eligibility is the extent to which medical professionals accept this insurance. Understanding the landscape of doctor participation is important for ensuring access to necessary healthcare services and managing potential costs.

Current Landscape of Doctor Acceptance

Most physicians across the United States actively participate in the Medicare program, making access to care broadly available for beneficiaries. As of November 2024, approximately 98% of non-pediatric physicians are enrolled in Medicare, indicating widespread commitment to serving this patient population.

While overall participation is high, 89% of office-based physicians accepted new Medicare patients in 2019. For primary care physicians, about 93% accept Medicare, though only around 70% are open to accepting new patients. This highlights that while many doctors accept Medicare, some may have limited capacity for new enrollees.

Acceptance rates vary by medical specialty and practice characteristics. Surgical specialists showed higher acceptance rates for new Medicare patients (96% in 2019) compared to primary care physicians (83% in 2019). Psychiatrists showed a lower acceptance rate at 60% in 2019, indicating potential access challenges within mental health services. Larger practice groups typically exhibit higher Medicare acceptance rates (92%) than solo practitioners (81%). Geographic variations in acceptance are minimal, with most states showing high rates of physician participation.

Understanding Medicare Acceptance

The term “accepting Medicare” involves specific categories of provider agreements that influence billing practices and patient costs. Physicians can enroll in Medicare as one of three types: participating, non-participating, or opt-out. Each category dictates how the physician interacts with Medicare and how patients pay for services.

Participating providers have a formal agreement with Medicare to accept the Medicare-approved amount as full payment for all covered services. They are paid directly by Medicare, and patients are only responsible for Medicare deductibles, coinsurance, or copayments. These providers receive a 5% higher reimbursement rate from Medicare than non-participating providers, incentivizing their full participation. In 2022, 98% of physicians billing Medicare were participating providers.

Non-participating providers accept Medicare patients but do not agree to accept the Medicare-approved amount for all services. They can choose to accept “assignment” on a case-by-case basis, agreeing to accept the Medicare-approved amount for that specific service. If a non-participating provider does not accept assignment, they can charge up to 15% above Medicare’s approved amount, known as the “limiting charge.” In these cases, the patient pays the full amount to the provider, and Medicare then reimburses the patient for its share. Non-participating providers who accept assignment are paid 95% of the Medicare-approved amount.

Opt-out providers have formally chosen to opt out of the Medicare program entirely. They do not submit claims to Medicare, and Medicare will not pay for their services. Patients seeing an opt-out provider are responsible for the full cost of care, as the provider can charge any amount. These arrangements require a signed private contract between the patient and the provider before services are rendered. Only about 1% of non-pediatric physicians formally opted out of Medicare in 2024, with highest rates among psychiatrists (8.1%), plastic surgeons (4.5%), and neurologists (3.2%), though remaining very low in most other specialties.

Locating Medicare-Accepting Providers

Finding a healthcare provider who accepts Medicare involves utilizing specific resources and confirming their status. The official Medicare website, Medicare.gov, offers a Physician Compare tool. This online directory allows beneficiaries to search for doctors by name, specialty, or location, and filter results based on their Medicare acceptance status.

It is advisable for beneficiaries to directly contact a doctor’s office to confirm their current Medicare acceptance status before scheduling an appointment. Provider participation statuses can change, and direct confirmation ensures up-to-date information regarding billing and coverage. This step helps prevent unexpected out-of-pocket costs.

For individuals enrolled in Medicare Advantage plans, checking the specific health plan’s provider network is important. Medicare Advantage plans often have their own networks of doctors and hospitals; services received outside this network may not be covered or may incur higher costs. State Health Insurance Assistance Programs (SHIPs) provide counseling and assistance to Medicare beneficiaries. These programs offer guidance on navigating provider networks and understanding coverage options.