About 1 to 2 percent of doctors in the United States do not accept Medicare. The formal opt-out rate, as of November 2024, stands at 1.2 percent of non-pediatric physicians, which translates to roughly 12,244 doctors nationwide. CMS reported a 98 percent participation rate for 2024, a figure that has held steady for years. So while the vast majority of doctors do accept Medicare, the picture gets more complicated when you look at which doctors are taking new Medicare patients, which specialties are hardest to access, and where you live.
Formal Opt-Out vs. Not Accepting New Patients
There’s an important distinction between a doctor who has formally opted out of Medicare and one who simply isn’t taking new Medicare patients. Opting out is a legal process: the physician files an affidavit with Medicare and agrees not to bill the program for any services for at least two years. Only 1.2 percent of doctors have done this. But a larger group of physicians technically participate in Medicare while limiting how many new Medicare patients they’ll see.
Among primary care doctors, 93 percent say they accept Medicare, which is nearly identical to the 94 percent who accept private insurance. But when asked whether they’re actively taking new Medicare patients, the number drops to 72 percent. For comparison, 80 percent of primary care doctors accept new patients with private insurance. That 8-point gap means Medicare beneficiaries can face longer wait times or need to call more offices before finding a doctor with availability, even though the formal opt-out rate is tiny.
Why Some Doctors Turn Away Medicare Patients
The core issue is money. Medicare typically pays less than private insurers for the same services. Nationally, Medicare’s fee schedule has historically been around 76 percent of what private insurance pays across all physician services, and the gap is far wider for certain types of care. Major procedures, for instance, can reimburse at roughly half the private insurance rate. For routine office visits the gap is smaller, but it still adds up for a practice seeing dozens of patients a day.
Administrative burden compounds the problem. Medicare’s billing rules, documentation requirements, and compliance regulations take time and staff to manage. For a small practice already operating on thin margins, the combination of lower pay and higher paperwork can make each Medicare patient a net financial loss. Some doctors respond by capping the number of Medicare patients they’ll see rather than opting out entirely, which lets them keep existing patients while limiting their exposure.
Specialties With the Highest Opt-Out Rates
Not all specialties are equally affected. Psychiatry stands out as the field where Medicare beneficiaries have the hardest time finding a provider. Mental health professionals opt out of Medicare at significantly higher rates than other specialists, driven by the fact that psychiatrists can often fill their schedules entirely with privately insured or self-pay patients willing to pay out of pocket. The reimbursement gap hits especially hard in specialties built around longer, one-on-one appointments rather than high-volume procedural work.
Primary care, by contrast, has relatively high acceptance rates. The structure of primary care, with its steady volume of patients and reliance on office visits where Medicare’s payment rates are closer to private insurance, makes participation more financially viable.
Where You Live Matters
Opt-out rates vary dramatically by state. Alaska and the District of Columbia have the highest rates, with 3 percent of doctors opting out. At the other end, several states report opt-out rates at or near zero: Mississippi, Nebraska, North Dakota, South Dakota, and West Virginia. The national average sits at about 1 percent.
The pattern loosely tracks the cost of living and the concentration of specialists. In expensive urban markets where doctors can attract enough privately insured and self-pay patients, opting out carries less financial risk. In rural areas with fewer physicians and fewer alternatives for patients, doctors are more likely to participate. Rural primary care physicians report accepting new Medicare patients at a rate of 81 percent, compared to 72 percent for their counterparts in cities. If you’re a Medicare beneficiary in a rural area, you may actually have an easier time finding a doctor who accepts your coverage than someone in a major metro area.
Medicare Advantage Adds Another Layer
If you have a Medicare Advantage plan rather than traditional Medicare, the math changes again. Medicare Advantage plans operate like private insurance networks, and not every doctor who accepts traditional Medicare is in a given Advantage plan’s network. KFF’s analysis found that Medicare Advantage enrollees have access to roughly half the physicians available to traditional Medicare beneficiaries. So even though 98 percent of doctors participate in Medicare broadly, your effective pool of available doctors can shrink considerably with an Advantage plan. Before enrolling in or switching Medicare Advantage plans, checking whether your current doctors are in-network is essential.
Older Doctors Are Less Likely to Accept New Patients
The age of the physician also plays a role. About 67 percent of primary care doctors age 55 and older say they accept new Medicare patients, compared to 76 percent of doctors under 55. This gap likely reflects a mix of factors: older physicians may have fuller patient panels, may be winding down their practices, or may feel the financial squeeze more acutely after years of watching Medicare reimbursement lag behind inflation. For Medicare beneficiaries, this means that as experienced physicians retire, replacing them with a new doctor who accepts Medicare could require some searching, particularly in areas with physician shortages.
What This Means in Practice
The headline number is reassuring: 98 to 99 percent of doctors participate in Medicare. But participation doesn’t guarantee access. The more practical figure for someone trying to find a new doctor is that roughly 72 percent of primary care physicians are actively accepting new Medicare patients, with the rate varying by specialty, geography, and the type of Medicare coverage you carry. If you’re having trouble finding a doctor, Medicare’s online physician finder tool lets you search specifically for providers accepting new Medicare patients in your area, filtered by specialty and location.