Medicare, the federal health insurance program designed to cover people age 65 and older (and some younger individuals with qualifying disabilities), provides health insurance for many American seniors.
The vast majority of doctors and hospitals accept Medicare, but they’re not required to, and the percentage of those who don’t accept Medicare has been increasing. According to January 2025 data from KFF, an independent health policy information resource, 1.2% of all nonpediatric physicians have formally opted out of the Medicare program.
KFF reports that the percentage of opt-outs varies by specialty: The highest is psychiatrists at 8.1%, followed by plastic and reconstructive surgeons at 4.5%. Across the board, these figures translate to more than 12,200 physicians who don’t accept Medicare (more than 1.2 million providers do participate in Medicare, according to 2023 data from the Centers for Medicare & Medicaid Services).
[READ: How Medicare Might Change for 2026 and How It Will Affect Your Coverage]
Why Some Doctors Don’t Take Medicare
The biggest reason a provider opts out of Medicare is money: Medicare typically reimburses providers less for services and procedures than private insurers do. Plus, Medicare, which is administered by the CMS, may pay significantly less than the full out-of-pocket retail prices that patients without insurance would be charged or that are billed to a private health insurance company.
Medicare can do this because it’s the largest payer for health care services in the United Sates. In 2023, for instance, Medicare spending reached $1,029.8 billion, the CMS reports. It also covers more than 68 million people, so it has volume on its side.
As the big kid on the block, CMS has a lot of leverage to negotiate prices and effectively compel providers to accept their payment terms. Medicare typically pays about 80% of what private health insurance companies pay, notes the Center for Medicare Advocacy, but for many providers, Medicare revenue is what keeps the doors open.
But as the American Medical Association noted in a 2024 report, Medicare physician payments are not keeping up with inflation. This means that for some practices and providers, Medicare payments haven’t been sustainable, says Adria Goldman Gross, a medical bill advocate with MedWise Insurance Advocacy, a division of MedWise Billing Inc. in Monroe, New York, and co-author of “Solved! Curing Your Medical Insurance Problems.”
“Either they’re having difficulties receiving payments, or they’re not being reimbursed at reasonable rates,” she explains.
Concerns about low payments from Medicare are also key to why some doctors aren’t keen on the idea of “Medicare for All” or similar single-payer system proposals that would make Medicare a universal health insurer for all Americans.
In addition, Medicare imposes strict rules on providers, and the paperwork related to getting paid can be onerous, so some providers are fed up and opting out. Still, when providers opt out of the Medicare network, that can leave some patients scrambling to access care.
Research shows 47% of people enrolled in Medicare began seeing a new doctor in the past year. While this churn is not entirely related to Medicare opt-outs, they are certainly part of the picture, notes Whitney Stidom, vice president of sales enablement with eHealth Inc., a health insurance broker and online resource provider.
Understanding Medicare doctor participation levels
While fewer than 2% of nonpediatric doctors formally opt out of Medicare, there are different levels of participation in Medicare, Stidom explains. These levels include:
— Participating providers. These doctors see Medicare patients and agree to accept Medicare’s reimbursement rates as payment in full. These providers also cannot refuse a Medicare supplement plan, also known as a Medigap plan.
— Nonparticipating providers. These doctors also see Medicare patients but may not accept Medicare reimbursement as payment in full for all services. This can mean the beneficiary will have to make up the difference between what Medicare pays and what the doctor charges out of pocket.
— True opt-outs. These doctors may still be willing to treat Medicare beneficiaries, but the individual must bear the full cost of treatment, as Medicare will not pay the doctor or reimburse you for care provided by an opt-out doctor.
[Read: Do I Have to Sign Up for Medicare If I Live Overseas?]
7 Options if Your Doctor Stops Accepting Medicare
If your doctor stops accepting your health insurance, these are some of your possible options:
1. Ask for clarification
Ask whether your doctor is dropping all Medicare plans, or just Medicare Advantage, advises Cindy George, a senior personal finance editor at GoodRx, a free website and mobile app that tracks prescription drug prices and provides coupons and discounts on medications.
“Some health care professionals may not accept Medicare Advantage because of the frequency of prior authorization or changes to in-network providers and facilities,” George explains.
These providers, however, may continue to accept original Medicare (Part A and Part B) or accept another specific Medicare Advantage plan. This is a key distinction, Stidom adds, as your preferred doctor may still be an option for you if you switch to another plan.
If your doctor does accept another plan, take advantage of the annual open enrollment period between October 15 and December 7 to understand what’s available to you. Be sure to check that any plan you’re considering includes other doctors you see and that any prescription coverage included in the plan will meet your needs; it may turn out that the plan your doctor will accept ends up being more expensive in the long run or otherwise can’t meet other needs you have.
To make this comparison-shopping process a little simpler, Stidom recommends connecting with a licensed insurance agent to help you wade through your options.
“The average beneficiary has more than 40 Medicare Advantage plans to choose from in their local area,” she notes.
A licensed agent can help you review plans from various insurance companies in your area based on your unique personal needs, usually at no cost to you.
[Read: Questions to Ask During Medicare Open Enrollment]
2. Pay out of pocket
If you want to stay with your doctor and you can afford it, you may be able to pay out of pocket for your health care. But remember, if the doctor is a nonparticipating doctor who’s formally opted out of Medicare, Medicare will not reimburse you for those out-of-pocket expenses.
However, some practices may be willing to enter into a direct primary care, or DPC, agreement.
“Under DPC, you typically pay a monthly fee that covers particular services, such as routine screenings, chronic condition management, care coordination and visits for acute issues,” George explains.
With a DPC, however, you have to sign an agreement stating that any services provided will not be billed to your Medicare plan.
“Some doctors, particularly specialists, may not consent to this arrangement,” she adds.
3. Negotiate the fees
If you’d prefer to stay with your doctor but they’re too expensive for you to afford out of pocket, ask if they’ll negotiate.
“Many doctors offer cash-pay discounts or flexible payment plans to help patients remain in their care,” says Lindsay Dymowski Constantino, co-founder and president of Centennial Pharmacy Services and LTC@Home Pharmacy Quality Commission, based in Philadelphia.
You may end up paying more than the Medicare rate but less than the full retail cost.
4. Find a new doctor
“If a direct payment isn’t feasible, it’s important to find a new provider as soon as possible to avoid any gaps in your care,” Dymowski Constantino says.
The CMS Medicare Physician Compare tool lets you assess doctors side by side so you can make an informed selection.
“The Medicare website is a helpful resource for locating providers in your area who accept new patients and participate in your plan,” Dymowski Constantino adds. “Some health care facilities specialize in serving Medicare beneficiaries and may have more experience and resources dedicated to handling the unique needs of Medicare patients.”
5. Request a referral
If your provider stops accepting Medicare, they may be able to recommend another local provider who still accepts it.
“It’s also a good idea to talk to family members or friends who are Medicare beneficiaries to see if they have recommendations,” Dymowski Constantino says.
Some health care networks and senior service organizations also offer resources to help Medicare patients connect with high-quality providers.
6. Talk to your pharmacist
“Pharmacies can be an anchor in your care, especially when other parts of your health care team change,” Dymowski Constantino says.
Not only might your pharmacist be able to make a recommendation for a good local health care provider who accepts Medicare, but they can also help maintain some elements of care during your transition.
“If you find yourself without a doctor or if you experience delays in establishing care with a new one, notify your pharmacy right away,” Dymowski Constantino adds. “A trusted pharmacy can provide support by coordinating with your historic providers for ongoing refills or helping connect you with community health resources.”
These efforts can help you avoid missed medications or lapses in care while you navigate your next steps.
7. Seek other sources of care
Depending on your needs, you may be able to visit an urgent care center, as most of them accept Medicare. This can be a good option for certain nonemergency, short-term issues, such as a cold, stitches or minor wound care, sprains and strains or routine vaccinations.
For more emergent or larger issues, you may need to visit an emergency room.
But relying on these alternative types of care long-term or for chronic conditions is not cost-effective and does not provide the continuity of care you’d get from a primary care provider, so it’s best to find a provider you can work with and build an ongoing relationship.
Find the Best Doctors and the Best Medicare Advantage and Medicare Part D Plans With U.S. News
To find a provider near you, visit U.S. News’ Best Doctors, search using your location or ZIP code and filter by insurance type, including Medicare.
To find the right insurance plan, check out U.S. News’ Best Insurance Companies for Medicare Advantage 2025 and Best Medicare Part D Companies. You can also look for and compare Medicare Advantage, Medicare Part D, bundled Medicare Advantage and Part D plans and Medigap plans near you with the U.S. News search and compare tool.
To determine the top-rated insurance companies, U.S. News consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers, applied these weights to data from the CMS and then adjusted for enrollment.
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What to Do When Your Doctor Stops Accepting Medicare originally appeared on usnews.com
Update 08/20/25: This story was previously published at an earlier date and has been updated with new information.
