Not every physician accepts both parts of your dual plan, and you need to check before your first visit.

A dual plan combines Medicare Part A (hospital coverage) and Part B (doctor visits) with a Medicaid plan from your state. When you see a doctor, that physician must accept both Medicare and your state's Medicaid to be in-network for you. Many doctors accept Medicare alone, some accept Medicaid alone, and some accept both. If your doctor accepts only one, you may pay out-of-pocket or need to find someone else.

The rules differ slightly by state because each state runs its own Medicaid program. Your state's Medicaid plan sets which doctors are in-network, and Medicare has its own separate network. You are covered only when a doctor is in-network for both programs at the same time.

Key Takeaways

  • Your doctor must be in-network for both Medicare and your state's Medicaid plan to avoid unexpected bills.
  • You can search for in-network doctors through Medicare.gov and your state Medicaid program's website, but you may need to call to confirm both acceptances.
  • If your current doctor does not accept both plans, you can ask their office to contact your Medicaid plan about joining, though they are not required to.
  • Emergency rooms must treat you regardless of network status, but non-emergency specialists often require in-network status to avoid high costs.
  • Your state Medicaid office can tell you which doctors in your area accept both Medicare and Medicaid, sometimes faster than searching online.

How to find doctors who accept both Medicare and Medicaid

Start by visiting Medicare.gov and using the "Find Care Providers" tool. Enter your location and search for your type of doctor. The results show which physicians accept Medicare, but this list alone is not enough — you still need to confirm Medicaid acceptance.

Next, go to your state's Medicaid website and search their provider directory. Each state names this differently: some call it "Find a Provider," others "Provider Search" or "In-Network Doctors." Enter the same doctor's name to see if they appear on your state's Medicaid list. If the doctor shows up on both Medicare.gov and your state Medicaid site, they likely accept both — but call the office to be certain before scheduling.

Calling the doctor's office is the fastest way to confirm. Ask the receptionist: "Do you accept Medicare and [your state] Medicaid?" Write down the answer and the date you called. If they say yes to both, ask whether they are currently taking new patients and whether they need any paperwork from you before your visit.

What happens if your doctor does not accept both plans

If your doctor accepts Medicare but not Medicaid, you will likely pay the full bill yourself. Medicare will not cover the visit because your doctor is not in-network for your Medicaid plan. The same applies in reverse: if they accept Medicaid but not Medicare, Medicare will not pay.

You have a few options. You can ask your doctor's office to contact your state Medicaid program and request to join the network. Some doctors will do this; many will not, because it requires paperwork and they may not want to accept Medicaid's lower payment rates. There is no penalty to asking, but do not expect a yes.

Your other choice is to find a different doctor who accepts both plans. Your state Medicaid office can often give you a list of doctors in your area who take both Medicare and Medicaid — sometimes faster than searching online yourself. Call your state Medicaid customer service line (the number is on your Medicaid card) and ask for in-network doctors near you who accept both plans.

Special rules for emergency care and specialists

Emergency rooms must treat you regardless of whether the hospital is in-network for both your Medicare and Medicaid. If you go to an emergency room, you are covered for emergency services even if the hospital does not normally accept your Medicaid plan. However, you should still tell the hospital staff about both your Medicare and Medicaid coverage so they bill correctly.

Specialists are different. If you need a cardiologist, rheumatologist, or other specialist, that doctor must be in-network for both plans to avoid high bills. Your primary care doctor can refer you to an in-network specialist, but the referral does not may provide the specialist accepts both plans — you still need to confirm before your appointment.

Some specialists work only with Medicare and do not contract with Medicaid at all. If this is the case, your primary care doctor may be able to refer you to someone who accepts both, or your state Medicaid office can suggest alternatives in your area.

What to do if you receive an unexpected bill

If you see a doctor you thought was in-network and receive a bill, do not ignore it. Call the doctor's office first and ask why you were billed. Sometimes the office made a mistake, or your coverage changed between the time you called and your visit.

If the doctor truly does not accept your Medicaid plan, contact your state Medicaid office and explain what happened. Medicaid can sometimes help resolve the bill, especially if you can show you made a good-faith effort to confirm the doctor was in-network. Keep copies of any bills, the date you called to confirm, and the name of the person who told you the doctor was in-network.

You can also file a complaint with your state Medicaid program if you believe a doctor misled you about accepting your coverage. Your state Medicaid office has a process for complaints, and they take them seriously because false claims about network status harm patients.

How your dual plan coverage works at the pharmacy

Pharmacies follow the same rule as doctors: the pharmacy must accept both Medicare Part D (prescription drug coverage) and your state Medicaid to avoid high costs. Most large chain pharmacies like CVS, Walgreens, and Walmart accept both, but smaller independent pharmacies may not.

When you fill a prescription, tell the pharmacist you have both Medicare and Medicaid. They will run both plans and use whichever one covers the drug at the lowest cost to you. If the pharmacy does not accept one of your plans, you may pay full price or need to transfer your prescription to a pharmacy that accepts both.

Frequently Asked Questions

Can I see any doctor I want with my dual plan?

You can see any doctor, but you will pay out-of-pocket if they do not accept both Medicare and your state Medicaid. To avoid unexpected bills, confirm in-network status before your visit by calling the office or checking both Medicare.gov and your state Medicaid website.

Do I need a referral from my primary care doctor to see a specialist?

Medicare does not require referrals for specialists, but your Medicaid plan may. Check your Medicaid plan documents or call your state Medicaid office to find out. If a referral is required and you do not have one, the specialist's office may refuse to see you or bill you directly.

What if my doctor dropped out of my Medicaid network?

Call your doctor's office to confirm they no longer accept your Medicaid. If they have dropped out, your state Medicaid office can help you find a replacement doctor in-network. You may also be able to request a continuity-of-care exception that allows you to keep seeing your doctor for a limited time while you transition.

Will I be charged if I go to an out-of-network doctor by mistake?

Yes, you will likely pay more or the full bill if you see an out-of-network doctor. This is why confirming in-network status before your visit is important. If you were told the doctor was in-network and received a bill, contact your state Medicaid office — they may be able to help resolve it.

How do I know if my dentist or eye doctor accepts both plans?

Dental and vision coverage vary by state Medicaid plan. Some states include dental or vision in Medicaid; others do not. Check your Medicaid plan documents or call your state Medicaid office to see what is covered, then search for in-network providers the same way you would for a regular doctor.