Call the doctor’s office to ask whether it accepts your Medicare coverage. With Original Medicare, also ask whether the doctor accepts Medicare’s approved payment amount. If your Medicare Advantage plan uses a network, check that the doctor is in your exact plan’s network. “Accepts Medicare” alone does not answer these questions.

If You Have Original Medicare

Search for the doctor using Medicare's official Care Compare tool, then call the office and ask three questions:

  1. Are you enrolled in Medicare?
  2. Are you accepting new Medicare patients?
  3. Do you accept Medicare assignment?

Accepting assignment means the provider agrees to accept the Medicare-approved amount as full payment for covered services. The provider cannot charge more than the approved amount for that service. You still owe applicable deductibles and coinsurance.

A deductible is the amount you pay for covered services before Medicare starts paying. Coinsurance is your share of a covered service’s cost.

Participating, Non-Participating, and Opt-Out Doctors

Medicare uses three important categories:

  • Participating: The provider accepts assignment for all Medicare-covered services.
  • Non-participating: The provider is enrolled in Medicare but may accept assignment case by case. For many services, the provider may charge up to 15% above the Medicare-approved amount.
  • Opted out: The provider has left Medicare for a set period. Medicare generally will not pay under a private contract. Special emergency and urgent-care rules can apply when no private contract is in place; ask Medicare about the particular claim.

Medicare explains these distinctions in its guide to providers and assignment.

For example, suppose Medicare’s approved amount for a covered service from a non-participating doctor is $100. Where the 15% limit applies, the doctor could charge up to $115. If you have met your deductible, Medicare would usually pay $80, leaving you $35 to pay without supplemental insurance. State rules may set a lower limit. See the full excess-charge example.

Use the CMS opt-out lookup as well as Care Compare. A valid private contract has different payment rules; the usual Medicare charge limits do not apply.

If You Have Medicare Advantage

If your plan uses a network, ask whether the doctor is in-network for the exact plan name and plan ID on your card. Simply accepting Medicare is not enough.

Verify with both:

  • The insurance plan, using its current provider directory or member service number
  • The doctor's office, giving the complete plan name

Ask whether the office location and individual clinician are in-network. Network contracts can differ by location and can change during the year.

Before Your Appointment

Confirm again if you are seeing a new clinician, visiting a different office, scheduling a procedure, or starting a new plan year. For hospital care, ask whether the facility and the clinicians who may bill separately participate.

If possible, save the date, representative's name, and reference number from your call.

If the office asks you to sign a private contract, read it before scheduling ordinary care. SHIP can help you understand the payment consequences.

Medicare policy sources last checked: October 8, 2026.