Having a doctor you trust in a convenient location is an important part of your healthcare. Verifying that your doctor accepts Medicare coverage or is in your Part C network can help you get the most from your Medicare benefits.

Whether you need to stay within a healthcare professional’s network depends on your plan type. With Original Medicare, you can get care from any doctor who accepts Medicare. Medicare Advantage (Part C) typically requires staying within a network.

A Health Maintenance Organization (HMO) plan provides a list of in-network professionals, and using out-of-network doctors may cost more. A Preferred Provider Organization (PPO) plan offers more flexibility, but you pay less for in-network doctors and more for out-of-network ones.

Keep reading to learn more about finding a doctor who accepts Medicare near you and why it matters.

While you can get care from a doctor who doesn’t accept Medicare, doing so may lead to higher rate charges for your care. Choosing a doctor who accepts Medicare can ensure your charges involve the negotiated and acceptable rate.

Your doctor’s office may also receive a bill from Medicare for your appointment. In most cases, a doctor who accepts Medicare may wait to hear back from Medicare before asking you to pay any cost difference if appropriate.

How to find out whether a doctor who accepts Medicare

You can find a doctor who accepts your Medicare plan in a few simple ways:

  • Original Medicare: VisitMedicare.gov to look up doctors near you and compare them side-by-side. You can also find and compare hospitals or other healthcare professionals and search for services your Medicare plan covers.
  • Medigap ad Part C: Check your insurance company’s healthcare professional listings. If your coverage includes a network of doctors and hospitals, ensure your doctor is in-network by calling your healthcare professional or visiting their website
  • Check other databases: Consider visiting Healthgrades.com and searching by doctor specialty in your area. From there, you can narrow the list by the type of insurance the doctor accepts and your plan. You can also view the doctor’s ratings and reviews. (Healthgrades is a sister site of Healthline.)
  • Ask trusted friends and family members: If you have any friends or family members who also use Medicare, ask them about their healthcare professionals. How attentive is the doctor? Does the office handle their requests promptly and with ease? Do they have convenient hours?

Not all doctors accept Medicare. When doctors accept Medicare, they agree to the Medicare-approved amount as full payment. This is known as “accepting assignment.”

Some healthcare professionals may agree to accept Medicare for certain services but not for others. This means they may charge substantially more than the Medicare-approved amount for those services they don’t accept. Other professionals may not accept Medicare at all.

As long as your current doctor accepts Medicare, you should be able to get care from them and receive coverage for it. However, if they decide not to accept Medicare or stop participating in the program, you must find another doctor.

If you join a Medicare Advantage plan, you can contact the insurance company directly to determine whether your preferred doctor is in your insurance coverage network. If not, you can choose a new doctor or insurance provider.

Often, insurance companies require you to have a referral, which is a written order from your primary care doctor, before they pay for a specialist’s care.

Original Medicare (parts A and B) doesn’t require referrals for specialist care. However, if you have Part A or Part B coverage through a Medicare Advantage (Part C) plan, you may need a referral before getting care from a specialist.

The specialist you get care from has to accept Medicare.

For most people, having a trusted doctor in a convenient location is an important part of their healthcare. While it’s an extra step, verifying that your doctor accepts Medicare coverage or is in your Part C network is important. This verification can help ensure you get the most from your Medicare benefits.