How to find doctors, hospitals, and other providers who accept your Medicare plan

Medicare has a search tool called Medicare.gov Provider Search that shows you which doctors, hospitals, urgent care centers, and other providers accept your specific plan. You enter your plan name or number, your location, and the type of provider you need — and the tool tells you who is in-network, meaning Medicare will pay them at the agreed rate. Out-of-network providers exist too, but they often cost you more out of pocket.

Your plan's member handbook or insurance card also lists a customer service phone number. Call that number and ask for a provider directory — they can tell you over the phone whether a specific doctor is in-network, and they can often answer questions about whether that doctor is currently accepting new patients. Many plans also mail you a printed directory when you first join.

If you are looking for a specific doctor you already see, call their office directly and ask which Medicare plans they accept. Many offices have a staff member whose job is to answer insurance questions, and they can tell you in minutes whether your plan will work there.

Key Takeaways

  • Medicare.gov Provider Search is the official tool to check whether a doctor or hospital accepts your plan before you make an appointment.
  • Your plan's customer service number (on your insurance card) can answer questions about whether a specific provider is in-network and accepting new patients.
  • In-network providers cost you less because Medicare pays them directly; out-of-network providers may require you to pay more upfront.
  • Calling a doctor's office directly is often the fastest way to confirm they accept your plan and have openings for new patients.
  • Your plan's member handbook lists covered services and any limits on which providers you can see without extra cost.

The difference between in-network and out-of-network providers

An in-network provider has a contract with your Medicare plan. Medicare and the provider have agreed on a price, and the provider bills Medicare directly. You pay your share (copay, coinsurance, or deductible, depending on your plan), and Medicare pays the rest. The provider cannot bill you for the difference.

An out-of-network provider does not have a contract with your plan. If you see them, you may have to pay the full bill upfront and then request reimbursement from Medicare, or the provider may bill you for any amount Medicare does not cover. Out-of-network care is usually more expensive for you. Some Medicare plans, like Original Medicare, cover out-of-network providers, but you pay a higher percentage of the cost. Other plans, like HMOs, may not cover out-of-network care at all except in emergencies.

Before you schedule an appointment with any provider, confirm whether they are in-network for your plan. This one step can save you hundreds of dollars.

Types of providers Medicare covers

Medicare covers many kinds of providers beyond primary care doctors. Specialists — cardiologists, orthopedists, neurologists, and others — are covered when referred by your primary care doctor (if your plan requires referrals) or when you see them directly (if your plan does not). Hospitals are covered for inpatient stays, emergency care, and outpatient services. Urgent care centers and emergency rooms are covered for urgent or emergency situations.

Mental health providers — psychiatrists, psychologists, and licensed counselors — are covered under Medicare Part B. Physical therapists, occupational therapists, and speech-language pathologists are covered when ordered by a doctor. Home health agencies provide nursing, therapy, and aide services at home when you are homebound or recovering from hospitalization. Durable medical equipment suppliers provide items like wheelchairs, walkers, oxygen, and hospital beds.

Dental providers, eye doctors for routine exams, and hearing aid providers are generally not covered by Original Medicare, though some Medicare Advantage plans include limited dental or vision coverage. Check your plan's member handbook to see what is covered in your situation.

How referrals work with different plan types

If you have an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plan, you may need a referral from your primary care doctor to see a specialist. A referral is a written request from your primary care doctor to another provider, saying that specialist care is medically necessary. Your primary care doctor sends the referral to the specialist's office, and it usually takes a few days to process.

With Original Medicare, you do not need a referral to see any provider — you can go directly to a specialist, urgent care, or hospital. However, some services (like physical therapy or mental health care) may require your doctor to order them first, even though you do not need a formal referral.

If your plan requires a referral and you see a specialist without one, you may have to pay the full cost yourself. Always check your plan's rules before scheduling. If you are unsure whether you need a referral, call your primary care doctor's office or your plan's customer service line.

Checking provider credentials and ratings

Medicare.gov Provider Search shows you basic information about each provider — their address, phone number, and whether they accept your plan. For more detail about a provider's background and patient ratings, you can visit Healthgrades.com, Zocdoc.com, or Google Reviews, where patients often leave comments about their experience.

You can also ask your primary care doctor for a recommendation. They know which specialists they trust and which ones have good working relationships with their office. Word-of-mouth from friends, family, or your local senior center can be valuable too — people often have strong opinions about their doctors and are willing to share.

If you want to know whether a provider has any disciplinary history, you can search the National Practitioner Data Bank (NPDB) through your state medical board's website, though this information is not always public. Your state medical board's website will tell you whether a doctor is licensed and whether there are any complaints on file.

What to do if your provider leaves your plan

Providers sometimes leave Medicare plans or stop accepting Medicare altogether. If your doctor leaves your plan mid-year, your plan must give you notice, usually by mail. You then have the right to see that provider for a limited time (often 30 to 90 days) while you find a new one, even though they are now out-of-network.

If this happens, contact your plan's customer service line right away. They can tell you how long you can continue seeing your current provider at in-network rates and help you find a new provider in your plan. You can also request a plan change during this time — if your current plan no longer works for you because your doctor left, you may be able to switch to a different plan outside the normal enrollment period.

To avoid this disruption, you can check your plan's provider directory every few months, especially if you see a specialist regularly. Providers sometimes announce they are leaving a plan before it becomes official, so staying aware helps you plan ahead.

Telehealth and virtual visits with Medicare providers

Many Medicare providers now offer telehealth visits — appointments by video or phone instead of in person. Medicare covers telehealth for many types of care, including primary care visits, specialist consultations, mental health visits, and follow-ups after hospitalization. You do not need special equipment; a phone or computer with internet is enough.

Telehealth visits are covered at the same rate as in-person visits, so your copay or coinsurance is usually the same. However, not all providers offer telehealth, and not all types of visits can be done remotely — a physical exam or blood draw, for example, still requires an in-person appointment.

When you call to schedule an appointment, ask whether the provider offers telehealth. If they do, ask what you need to do to set it up — some use a straightforward video link, while others use a patient portal or app. If you are not comfortable with technology, ask whether a family member can help you, or ask the provider's office if they can walk you through it over the phone.

Frequently Asked Questions

Can I see any doctor I want with Medicare?

With Original Medicare, yes — you can see any provider who accepts Medicare without a referral. With Medicare Advantage plans (HMO or PPO), you must see in-network providers, and some plans require a referral to see a specialist. Check your plan's rules before scheduling.

What happens if I see an out-of-network provider by mistake?

Call your plan's customer service line right away and explain what happened. Some plans will cover the visit at in-network rates if the provider was not clearly marked as out-of-network or if it was an emergency. Others may ask you to pay the difference. The sooner you report it, the better your chances of getting help.

How do I find a new primary care doctor?

Use Medicare.gov Provider Search and filter for primary care doctors in your area who accept your plan. Call their office to confirm they are accepting new patients. Your plan's customer service line can also send you a list of in-network primary care doctors near you.

Do I need a referral to see a mental health provider?

With Original Medicare, no. With an HMO or PPO plan, it depends on your plan — some require a referral, others do not. Check your member handbook or call your plan to find out. Many plans cover mental health visits at the same rate as physical health visits.

What if my doctor is not listed in the Medicare.gov Provider Search?

Call your plan's customer service number and ask directly. The online directory is usually up to date, but there can be delays. The customer service team can confirm whether your doctor is in-network and help you understand any coverage limits.