Will Your Doctor Still Accept Medicare in 2026? Check Now
While most of the Medicare focus in the fall is on the Annual Enrollment Period for beneficiaries, there’s a critical deadline approaching for healthcare providers that could directly impact your access to care in 2026.
The Centers for Medicare & Medicaid Services (CMS) has issued its annual reminder to all physicians and healthcare suppliers: they must decide by December 31, 2025 whether to participate in Medicare for the 2026 calendar year.
Here’s what this means for you as a Medicare beneficiary and why it matters for your healthcare.
What is “Medicare Participation” for a Doctor?
In simple terms, a provider’s “participation” status defines their relationship with Medicare and, by extension, with you, the patient.
- Participating Providers: These providers have an agreement with Medicare to “accept assignment” on all Medicare patients. This is the most straightforward and cost-effective scenario for you.
- Non-Participating Providers: These providers do not have an agreement with Medicare. They can choose to accept assignment on a case-by-case basis. This can lead to higher and less predictable out-of-pocket costs for you.
Why This Decision Affects Your Care and Costs
The financial implications for providers directly influence your experience as a patient. Here’s the breakdown from the recent CMS announcement:
For You, the Patient, Seeing a Participating Provider is Best:
- You Pay Less: You are only responsible for the Medicare-approved amount (after your Part B deductible is met). The provider agrees to this amount as payment in full.
- Direct Billing: Medicare pays the provider directly, and the provider handles the claim. This is a hassle-free experience for you.
- Seamless Medigap Coordination: Medicare automatically forwards claim details to your Medigap (Medicare Supplement) plan for secondary payment. You don’t have to file a separate claim.
The Risks of Seeing a Non-Participating Provider:
- A non-participating provider is paid 5% less by Medicare than a participating provider for the same service.
- To compensate, they can charge you up to 15% more than the Medicare-approved amount (known as a “Limiting Charge”). This is an out-of-pocket cost that you are responsible for.
- The billing process can be more complex, potentially requiring you to pay upfront and seek reimbursement yourself.
What You Should Do Before Seeking Care in 2026
This provider deadline is a timely reminder for you to be proactive about your own care network.
- Always Verify Participation: Before scheduling an appointment with a new specialist or provider in 2026, always call their office and ask, “Do you accept Medicare assignment?” Getting a “yes” ensures you will receive the full financial protections of Medicare.
- Double-Check During Open Enrollment: If you are enrolling in a Medicare Advantage Plan, this is especially critical. Ensure your favorite doctors and specialists are not only in the plan’s network but are also participating providers to avoid surprise charges.
- Understand the Terms: Know the difference between a provider who “accepts Medicare” (they are enrolled in the program) and one who “accepts assignment” (they are a participating provider who agrees to the set fees). The latter is what saves you money.
A Stable Network Means Peace of Mind
At Medicare.social, we believe that understanding these behind-the-scenes details empowers you to make the best healthcare decisions. A network of fully participating providers is key to predictable costs and seamless care.
If you’re reviewing your Medicare Advantage or Medigap plan during Open Enrollment and want to ensure your providers are in-network and participating, we can help.
Schedule a free consultation with a Medicare.social expert today. Let us help you confirm your coverage for 2026, so you can focus on your health, not on surprise medical bills.
