How to Find a Primary Care Doctor Who Accepts Medicare and Is Taking New Patients

A good primary care doctor is the center of your health care on Medicare, but finding one who accepts Medicare and is taking new patients can take some work.

Some practices have long waits, some don't accept Medicare at all, and Medicare Advantage plans may limit you to doctors in their network. This guide explains how Medicare covers primary care, how to find a doctor near you who accepts your coverage, and what to do during Medicare Open Enrollment if your doctor isn't in your plan.

How Medicare Covers Primary Care

Under Original Medicare, Part B covers visits to your primary care doctor. After you meet the yearly Part B deductible, you generally pay 20% of the Medicare-approved amount for most doctor services.

Medicare also covers two important preventive visits:

• The "Welcome to Medicare" preventive visit, available within the first 12 months after your Part B coverage starts
• A yearly Wellness visit to create or update a prevention plan

You usually pay nothing for these visits if your doctor accepts assignment, though you may owe a share of the cost if other tests or services are done during the same visit.

What "Accepts Medicare" Really Means

Doctors fall into a few groups, and the difference affects what you pay:

• Participating providers accept assignment. They agree to take Medicare's approved amount as full payment, so you pay only your deductible and coinsurance.
• Non-participating providers accept Medicare patients but don't always accept assignment. They can charge up to 15% more than the Medicare-approved amount for some services.
• Opt-out providers don't bill Medicare at all. You'd sign a private contract and pay the full cost yourself.

When you call a practice, ask specifically: "Do you accept Medicare assignment, and are you taking new Medicare patients?"

Primary Care With a Medicare Advantage Plan

If you have a Medicare Advantage plan (Part C), the rules depend on your plan type. HMO plans usually require you to choose a primary care doctor in the plan's network and may require a referral before you see a specialist. PPO plans let you see out-of-network doctors, usually at a higher cost. Always check that a doctor is in your plan's network before your first visit, because network lists change.

How to Find a Primary Care Doctor Accepting New Medicare Patients

1. Use Medicare's online Care Compare tool to search for doctors and clinicians near you who accept Medicare.
2. If you have Medicare Advantage, use your plan's provider directory, or call the member services number on your card and ask for in-network doctors taking new patients.
3. Call practices directly to confirm they accept Medicare assignment or your plan, and ask how soon a new patient can be seen.
4. Ask for referrals from friends, family, specialists you already see, or a local hospital's physician referral line.
5. Consider other types of primary care, including nurse practitioners and physician assistants, community health centers, and geriatricians, who specialize in care for older adults.

Questions to ask before choosing a doctor

• Do you accept Medicare assignment or my Medicare Advantage plan?
• How long is the wait for a new patient appointment?
• Can I reach the office or a nurse line after hours?
• Do you offer telehealth visits?
• Which hospital are you affiliated with?

Be aware that some "concierge" or membership practices charge an annual fee on top of what Medicare pays. Medicare doesn't cover that fee, so ask about it up front.

Medicare Open Enrollment: Make Sure Your Doctor Is Covered

The Medicare Open Enrollment Period runs from October 15 to December 7 each year. During this time, you can switch between Original Medicare and Medicare Advantage or change Medicare Advantage plans, with changes taking effect January 1. If you want to keep a particular doctor, check that they're in the network of any plan you're considering. If you're already in a Medicare Advantage plan, you can also make one plan change from January 1 to March 31.

Where to Get Medicare Help

• Speak to a Medicare representative at 1-800-MEDICARE (1-800-633-4227) for help with coverage questions and finding providers.
• Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased one-on-one help comparing plans and checking whether your doctors are covered.
• Call your plan to confirm whether a specific doctor is in network.

Medicare covers more than doctor visits. Recommended vaccines are covered under the drug benefit, as our article on the shingles vaccine under Medicare explains, and some medical equipment your doctor prescribes may be covered too, as our guide to Medicare coverage for walkers describes.

Frequently Asked Questions

Why is it hard to find a doctor who accepts new Medicare patients?

Some practices are full or limit how many Medicare patients they take. Checking several sources and asking to be put on a waiting list can help.

Do I need a referral to see a primary care doctor on Medicare?

No. With Original Medicare you can see any doctor who accepts Medicare. Some Medicare Advantage HMO plans require you to choose an in-network primary care doctor.

Is the yearly Wellness visit the same as a physical?

No. The Wellness visit focuses on a prevention plan and health risk review. A routine physical exam isn't covered by Original Medicare, though some Medicare Advantage plans cover one.

This article is general information, not medical or insurance advice. Coverage, costs and provider participation vary, so confirm details with Medicare, your plan and the doctor's office.