Medicare Providers

A Medicare provider is a physician, health care facility or agency that accepts Medicare insurance. Providers earn certification after passing inspection by a state government agency. Make sure your doctor or health care provider is approved by Medicare before accepting services.

Rachel Christian, writer and researcher for RetireGuide
  • Written by
    Rachel Christian

    Rachel Christian

    Financial Writer and Certified Educator in Personal Finance

    Rachel Christian is a writer and researcher for RetireGuide. She covers annuities, Medicare, life insurance and other important retirement topics. Rachel is a member of the Association for Financial Counseling & Planning Education.

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    Matt Mauney
    Matt Mauney, Senior Editor for RetireGuide

    Matt Mauney

    Financial Editor

    Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for,, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.

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  • Reviewed By Megan Christensen
  • Published: June 9, 2020
  • Updated: October 9, 2023
  • 3 min read time
  • This page features 8 Cited Research Articles
Fact Checked
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A licensed insurance professional reviewed this page for accuracy and compliance with the CMS Medicare Communications and Marketing Guidelines (MCMGs) and Medicare Advantage (MA/MAPD) and/or Medicare Prescription Drug Plans (PDP) carriers’ guidelines.

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APA Christian, R. (2023, October 9). Medicare Providers. Retrieved May 18, 2024, from

MLA Christian, Rachel. "Medicare Providers.", 9 Oct 2023,

Chicago Christian, Rachel. "Medicare Providers." Last modified October 9, 2023.

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Types of Medicare Providers

Primary care physicians are just one type of Medicare provider. Original Medicare (Part A and Part B), Medicare Advantage (Part C) or Medicare Supplement plans may also cover other services and facilities.

Types of Medicare providers can include:
  • Doctors and clinicians
  • Hospitals
  • Nursing homes
  • Home health services
  • Inpatient rehabilitation facilities
  • Long-term care hospitals
  • Dialysis facilities

What Doctors Are Covered by Medicare?

Original Medicare beneficiaries have access to doctors and health care facilities throughout the United States. Recipients may be limited to a provider network depending on additional coverage purchased.

According to a 2022 survey by the Kaiser Family Foundation, virtually all primary care providers accepted Medicare while only a small fraction — 3% according to a 2020 KFF analysis — opt-out. The 2022 survey also found that 89% of non-pediatric primary care providers accept new Medicare patients.

Original Medicare participating providers accept Medicare and most take assignment.

You can use the Physician Compare tool to view providers in your local area.
Source: U.S. Centers for Medicare & Medicaid Services

Medicare Providers Under Part C

Many Medicare Advantage plans maintain provider networks.

Most Part C plans, including Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans, require you to utilize a network of Medicare providers in order to reduce cost. This means that some doctors and health care facilities may be excluded from your network, even if they are Medicare-certified providers.

You can still visit these out-of-network providers — but your care will cost more.

However, these rules don’t apply to emergency care. Medicare Advantage plans must still cover emergency room expenses at in-network rates, even if you use an out-of-network facility.

Each Medicare Advantage plan is required to include an adequate number of in-network providers and hospitals.

To become Medicare certified, providers must complete an application form and pass inspection by a state government agency.

Once Medicare approves a provider, they are assigned a National Provider Identifier and a Medicare billing number.

Medicare can cover services provided by:
  • Clinical social workers
  • Physical therapists
  • Physician assistants
  • Nurse practitioners
  • Occupational therapists
  • Speech language pathologists
  • Clinical psychologists

Nonparticipating and Opt-Out Providers for Medicare

Not all providers accept Medicare.

Nonparticipating providers accept Medicare but do not agree to take assignment in all cases. These providers can charge up to 15 percent more than the official Medicare reimbursement amount.

In other words, you can still visit a nonparticipating provider — but it’s likely to cost you more money.

It’s important to note that you may be able to cover some or all of these extra expenses — known as excess charges — with a Medigap Supplement insurance policy or Medicare Advantage plan.

Some states don’t allow excess charges at all.

If you are unsure how to select Medicare coverage that includes your current health care providers, free assistance is available in every state from the State Health Insurance Assistance Program (SHIP).

Opt-out providers do not accept Medicare at all. These doctors and health care facilities can charge whatever they want for services and you will be responsible for the entire cost of your care. Opting out of Medicare means those providers can’t see Medicare beneficiaries without disclosing the full cost of care up front and entering into a private contract where the patient agrees to bear responsibility for the full price of services rendered.

As of April 2022, about 28,000 providers have opted out of Medicare — and 43% of those worked in behavioral health disciplines, according to an analysis of Medicare data by Behavioral Health Business.

Last Modified: October 9, 2023

8 Cited Research Articles

  1. Ochleng, N., et al. (2022, May 12). Most Office-Based Physicians Accept New Patients, Including Patients With Medicare and Private Insurance. Retrieved from
  2. Larson, C. (2022, April 26). 43% of Medicare Opt-Outs Are Behavioral Health Providers. Retrieved from
  3. Ochleng, N., et al. (2020, October 22). How Many Physicians Have Opted-Out of the Medicare Program? Retrieved from
  4. Centers for Medicare & Medicaid Services. (2020, October 16). Opt-Out Affidavits. Retrieved from
  5. Boccuti, C. et al. (2015, October 30). Primary Care Physicians Accepting Medicare: A Snapshot. Retrieved from
  6. (n.d.). Contact Information and Websites of Organizations for Medicare. Retrieved from
  7. (n.d.). Find & compare doctors, hospitals & other providers. Retrieved from
  8. (n.d.). Doctor & other health care provider services. Retrieved from