Doctor stops accepting Medicare is a growing concern for millions of beneficiaries across the country. According to KFF analysis of CMS data, over 12,000 non-pediatric physicians have formally opted out of Medicare. That represents about 1.2% of all active physicians.
The number may sound small. However, certain specialties see much higher opt-out rates — 8.1% in psychiatry and 4.5% in plastic surgery. For beneficiaries who rely on a specific doctor for ongoing care, losing Medicare access to that provider can feel overwhelming. Understanding your options ahead of time makes the transition far less stressful. You have more protections and alternatives than you might realize.
Why Your Doctor Stops Accepting Medicare
Physicians leave Medicare for several reasons. Payment rates are a major factor. Medicare reimbursement has not kept pace with inflation, and a 2.93% payment cut took effect in January 2025. Some doctors find that Medicare payments no longer cover their practice costs. As a result, they choose to opt out entirely or become non-participating providers.
There is an important distinction between these two categories. A non-participating provider still works within the Medicare system. They can charge up to 15% above the Medicare-approved amount — known as the limiting charge. Medicare still pays its share, and the provider must submit claims on your behalf. An opt-out provider, on the other hand, leaves Medicare completely. You must sign a private contract and pay entirely out of pocket. Medicare will not reimburse any portion of those costs, except in emergencies.
Some states impose stricter limits. For example, New York caps the limiting charge at just 5% above the approved amount. Knowing which category your doctor falls into determines your next steps.
What to Do When Your Doctor Stops Accepting Medicare
First, confirm what actually changed. Call your doctor’s office and ask whether they opted out of Medicare entirely or simply became a non-participating provider. If they are non-participating, you can typically still see them. Your out-of-pocket costs will be higher, but Medicare still covers its share. Medigap Plans F and G can cover the excess charges, eliminating that 15% surcharge entirely.
If your doctor has fully opted out, you need a new provider. The best starting point is Medicare Care Compare on Medicare.gov. This free tool lets you search for Medicare-participating doctors by location and specialty. It is updated regularly by CMS. You can also call 1-800-MEDICARE (1-800-633-4227) for help finding providers in your area.
Beneficiaries in the middle of active treatment have additional protections. The No Surprises Act allows up to 90 days of continued care at in-network rates during transitions. This applies to situations like chemotherapy, post-surgical recovery, or pregnancy. Medicare Advantage enrollees must receive at least 30 days’ written notice when an in-network provider leaves their plan.
Getting Help After Your Doctor Stops Accepting Medicare
Free, unbiased counseling is available through your State Health Insurance Assistance Program (SHIP). SHIP counselors help Medicare beneficiaries find new providers, compare plan options, and understand their rights. They do not sell insurance. You can reach SHIP at 1-877-839-2675 or visit shiphelp.org to find your local office.
Consider whether your current coverage still fits your needs. If a doctor stops accepting Medicare and you are on Original Medicare, switching to a Medicare Advantage plan with a broad network might give you more provider options. Major insurers like UnitedHealthcare, Humana, Blue Cross, Aetna, and Cigna offer Medicare Advantage plans in most areas. In contrast, if you are on Medicare Advantage and your doctor left that plan’s network, returning to Original Medicare with a Medigap supplement may offer greater flexibility. Medigap plans from carriers like Mutual of Omaha let you see any Medicare-participating provider nationwide.
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Keep in mind that switching between Original Medicare and Medicare Advantage is generally limited to specific enrollment periods. The Annual Election Period runs from October 15 through December 7 each year. Planning ahead gives you the most options when a provider change occurs.
Frequently Asked Questions
Does my doctor have to notify me before dropping Medicare?
There is no federal requirement for doctors to give advance notice before leaving Original Medicare. However, Medicare Advantage plans must provide at least 30 days’ written notice when a network provider is terminated. In most cases, you will find out through your doctor’s office directly.
Can I still see a doctor who stops accepting Medicare if I pay out of pocket?
Yes, but only if the doctor has formally opted out and you sign a private contract. Medicare will not reimburse any costs for services from an opt-out provider. Typically, these visits are significantly more expensive than seeing a participating provider.
Will my Medigap plan cover visits to a doctor who stops accepting Medicare?
It depends on the doctor’s status. If the doctor is non-participating but still enrolled in Medicare, Medigap can help cover excess charges. Plans F and G specifically cover the 15% limiting charge. Medigap will not pay anything for opt-out providers, since Medicare itself pays nothing in that situation.
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Official Sources & Resources
For verified information on Medicare regulations and consumer protection:
- Medicare.gov (Official Site): medicare.gov
- CMS (Centers for Medicare & Medicaid Services): cms.gov
- NAIC (National Association of Insurance Commissioners): naic.org
- KFF Medicare Research: kff.org/medicare
- Social Security Administration: ssa.gov
Content last reviewed June 2026. If you notice any outdated information, please contact us.