The 5-Step Process
Determine your Medicare plan type
Confirm whether you have Original Medicare (Parts A and B), a Medicare Advantage plan (Part C), or Original Medicare plus a Medigap supplement. Original Medicare lets you see any Medicare-participating doctor nationwide. Medicare Advantage typically has a network you must stay within.
Use Medicare.gov Care Compare
Go to medicare.gov/care-compare. Enter your ZIP code, specialty, and preferred filters (language, gender, accepting new patients). Results show whether the doctor accepts Medicare assignment and provides patient ratings from Medicare's own quality data.
Confirm participation directly with the practice
Call the practice and ask three specific questions: "Do you accept Medicare?" "Do you accept Medicare assignment?" "Are you accepting new Medicare patients?" Get the answers in writing when possible - directory data can lag behind practice-level changes.
For Medicare Advantage, use your plan's provider directory
Medicare Advantage plans have their own networks that differ from Original Medicare. Use the plan's online provider directory or call member services (the number on your card). Out-of-network care is either not covered or covered at higher cost.
Verify board certification and license
Once you have a candidate, cross-check them on The Doctor Directory for verification, and at certificationmatters.org for board certification. See how to check a doctor's license.
Medicare Participation Status Types
| Status | What it means | Your out-of-pocket |
|---|---|---|
| Participating (accepts assignment) | Doctor accepts Medicare-approved amount as full payment | 20% of Medicare-approved amount after Part B deductible |
| Non-participating (accepts Medicare, not assignment) | Can charge up to 15% above Medicare-approved amount (the "limiting charge") | 20% + up to 15% excess |
| Opted out | Doctor has formally opted out of Medicare | You pay 100%; must sign a private contract |
| Medicare Advantage network provider | In-network for your specific MA plan | Your plan's copay/coinsurance |
Common Situations
Snowbirds and dual-state residents
Original Medicare covers you in any state where the doctor participates in Medicare. Medicare Advantage often does not - most MA plans restrict routine care to your home service area. If you spend part of the year elsewhere, Original Medicare + Medigap is typically the better fit.
New to Medicare
Establish a primary care doctor within the first 60 days. Medicare covers a free "Welcome to Medicare" preventive visit in your first 12 months of Part B enrollment. Bring your medication list, health history, and questions.
Changing doctors after signing up for Medicare
You can change doctors at any time under Original Medicare - no referral or approval needed. Under Medicare Advantage, changing may require a PCP change through member services and may affect your specialist referrals.
Frequently Asked Questions
How do I know if a doctor accepts Medicare?
Search Medicare.gov Care Compare or call the practice and ask three questions: (1) Do you accept Medicare? (2) Do you accept Medicare assignment (agreeing to Medicare's approved amount as full payment)? (3) Are you accepting new Medicare patients? A doctor who accepts Medicare but not assignment can charge up to 15% above the Medicare-approved amount.
What is Medicare assignment?
Medicare assignment means the doctor agrees to accept Medicare's approved amount as full payment for a covered service. Doctors who accept assignment are called "participating providers." Doctors who accept Medicare but not assignment can charge up to 15% more than the Medicare-approved amount (called the "limiting charge"). You pay this extra amount out of pocket.
Does Medicare cover telehealth?
Yes. Medicare covers many telehealth services in 2026 including primary care, mental health, and specialty follow-ups. Coverage rules expanded during COVID have been largely made permanent. The provider must be Medicare-enrolled and licensed in your state.