Why Does My Doctor No Longer Accept Medicare?

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Doctors make the decision to stop accepting Medicare for various reasons. Sometimes they need to reduce overhead costs. Other doctors may need to reduce their caseload in order to maintain quality care.

Impact on Patient

If your doctor no longer accepts Medicare, it means the doctor will no longer be offering the Medicare- reduced cost of service. If you continue using the doctor, you will need to pay 100% of the cost. Because your costs are lowest if you see a Medicare-participating doctor or provider, you may want to consider making a change.

Switching to a Medicare-Participating Doctor or Provider

Participating providers will not charge you above the Medicare-approved amounts for a service. Copayments, coinsurance, and deductibles will need to be covered by the patient.

Using Your Doctor as a Non-Participating Provider
Other situations may occur where your doctor chooses on an individual basis whether or not to accept Medicare. The doctor is known as a non-participating provider.

If a provider does not accept Medicare for a particular service, it means he or she does not accept the reduced Medicare cost and can charge you what is known as a limiting charge. This charge can be up to 15% more for his or her service.

Finding a New Provider If Yours No Longer Accepts Medicare

Original Medicare (Part A and Part B)
If you use Part A and Part B, but your doctor chooses not to use the Medicare program, consider finding a new doctor through Medicare.gov’s Physician Compare website. This website includes a database of providers across the country. All are enrolled in the Medicare program either as participating or non-participating doctors.

Doctors and providers can be filtered by:

  • Location and zip code
  • Area of practice (for example, cardiology)
  • Gender
  • Hospital affiliation
  • Your doctor’s last name
  • Participating or non-participating doctor

After finding a physician, it is always a good idea to call to confirm that the provider accepts Medicare assignment and is accepting new patients.

Medicare Advantage

Switching to a new Medicare Advantage plan generally needs to be done during the Annual Election Period which runs from October 15 to December 7. A patient may do this if his or her doctor is part of another Medicare Advantage plan’s provider network.

The Centers for Medicare & Medicaid Services (CMS) sometimes decide that the change in provider network was significant and create a Special Election Period. If this applies to you, your Medicare Advantage plan will contact you. You may then use this time to enroll in another Medicare Advantage plan.

The following are reasons for a Special Election Period:

  • The Medicare Advantage plan does not renew its contract or limits its service area.
  • The Medicare Advantage plan makes significant changes in its contract with CMS.
  • The Medicare Advantage plan breaches its contract with CMS.
  • CMS ends the Medicare Advantage plan’s contract.

Switching to Original Medicare from the Medicare Advantage Plan is another option. If your doctor no longer accepts a Medicare Advantage Plan but does accept Original Medicare, you can use the Annual Election Period (or the Special Election Period if it applies) to disenroll and return to Original Medicare.

You can also disenroll from your plan during the Medicare Advantage Disenrollment Period (January 1 to February 14). In addition, you can use this period to enroll in the Medicare Prescription Drug plan.

Need Help Finding a Medicare Plan?

For help finding a Medicare plan or Medicare Prescription Drug plan, try our Medicare Plan Finder. If you have any questions, please contact Medicare at any time at 1-800-MEDICARE (1-800-633-4227; TTY users 1-877-486-2048)