Not all hospitals accept Medicare, and some accept it only for certain services
Most hospitals in the United States accept Medicare, but not all of them do. Some hospitals have chosen not to participate in the Medicare program, and a small number of specialty hospitals or facilities may accept Medicare only for specific types of care. Before you need emergency or planned care, it is worth knowing whether your nearest hospital is in-network for your Medicare coverage.
The hospitals that do accept Medicare are called participating providers. They have signed an agreement with Medicare to accept Medicare's payment rates and to follow Medicare rules. When you receive care at a participating hospital, Medicare pays its share and you pay your share — usually a copay, coinsurance, or deductible. If you go to a hospital that does not participate in Medicare, you may face much higher out-of-pocket costs, and Medicare may pay little or nothing toward your bill.
Key Takeaways
- Most hospitals accept Medicare, but you should verify that your preferred hospital is a participating provider before you need care.
- You can search for in-network hospitals using Medicare's official provider search tool on Medicare.gov.
- If you have a Medicare Advantage plan (Part C), your hospital network may be smaller than Original Medicare's, so check your plan documents or call your plan.
- In a true emergency, go to the nearest hospital regardless of network status — Medicare will cover emergency stabilization even at non-participating hospitals.
- Non-participating hospitals may bill you for the full cost of care, so it is important to know your hospital's status before planned procedures.
How to learn about a specific hospital accepts Medicare
The fastest way to check is to use the Medicare Provider Search tool on Medicare.gov. Go to the search page, enter the hospital name and your state, and the tool will tell you whether that hospital participates in Medicare. The search also shows you the hospital's address, phone number, and whether it has any special certifications.
If you have a Medicare Advantage plan (also called Part C), you also need to check your plan's provider network. Medicare Advantage plans contract with specific hospitals and doctors, and their networks are often narrower than Original Medicare's. Your plan documents or your plan's website will list in-network hospitals. You can also call your plan's customer service number — it is on your insurance card — and ask whether a specific hospital is in-network for your plan.
If you use Original Medicare (Part A and Part B without a Medicare Advantage plan), most participating hospitals will accept you. However, some hospitals may not participate, so it is still worth checking before you schedule a procedure.
What happens if you go to a non-participating hospital
If you receive care at a hospital that does not participate in Medicare, you may owe significantly more money. A non-participating hospital can charge you more than Medicare would normally pay, and Medicare may cover only a portion of the bill. You could receive a bill for the difference between what the hospital charges and what Medicare pays.
Some non-participating hospitals are non-emergency facilities — for example, certain specialty hospitals or surgical centers that handle only planned procedures. If you schedule surgery or another planned procedure at a non-participating facility, you should understand the costs before you go. Ask the hospital for an estimate of what you will owe out of pocket.
In an emergency, the rules are different. If you need emergency care and the nearest hospital does not participate in Medicare, go there anyway. Medicare will cover the emergency stabilization and treatment, even at a non-participating hospital. After you are stable, the hospital may transfer you to a participating facility if needed.
Differences between Original Medicare and Medicare Advantage networks
Original Medicare (Part A and Part B) has a nationwide network. Any hospital that participates in Medicare will accept your Original Medicare coverage, no matter where you live or travel. This gives you flexibility to seek care at any participating hospital without worrying about whether it is "in-network."
Medicare Advantage plans work differently. Each plan has its own network of hospitals and doctors. If you use a hospital outside your plan's network, you may pay more out of pocket, or your plan may not cover the care at all (except in emergencies). Some Medicare Advantage plans offer out-of-network coverage, but usually at a higher cost to you. Before you choose a Medicare Advantage plan, review its hospital network to make sure your preferred hospitals are included.
If you travel frequently or spend time in multiple states, Original Medicare may be a better fit because you do not have to worry about changing networks. If you stay in one area and prefer to use the same hospitals and doctors, a Medicare Advantage plan with a strong local network may work well for you.
What to do before a planned hospital stay or procedure
Before you schedule any planned procedure or hospital stay, call the hospital's billing or admissions department and confirm that it participates in Medicare. If you have a Medicare Advantage plan, also confirm that the hospital is in-network for your specific plan. Ask the hospital to estimate what you will owe out of pocket, including any deductibles, copays, or coinsurance.
If the hospital is not a participating provider and you still want to have your procedure there, ask the hospital for a written estimate of all charges. You may also want to ask whether the hospital offers a payment plan or financial information. Some non-participating hospitals will work with you on costs, especially if you explain your situation.
If you are having surgery or a major procedure, also ask whether the surgeon, anesthesiologist, and other doctors involved are in-network for your insurance. Sometimes a hospital participates in Medicare, but the doctors working there do not. This can result in surprise bills if you are not careful. Your hospital's admissions staff can help you verify that all providers involved in your care are in-network.
Medicare coverage in rural and remote areas
In rural or remote areas, there may be fewer hospitals that participate in Medicare, or only one hospital serving a large region. If your nearest hospital does not participate in Medicare, you have limited options. You can ask your doctor whether there is a participating hospital within a reasonable distance, or you can contact your state's Medicare office for guidance on coverage in your area.
Some rural hospitals have special Medicare agreements that allow them to operate under different rules. If you live in a rural area and your local hospital does not participate in traditional Medicare, ask whether it participates in any Medicare program or whether it has a special arrangement with Medicare.
What to ask your doctor or hospital
Before any planned care, ask your doctor or hospital these questions:
- Does this hospital participate in Medicare?
- If I have a Medicare Advantage plan, is this hospital in-network for my plan?
- What will I owe out of pocket for this procedure or stay?
- Are all the doctors involved in my care (surgeon, anesthesiologist, radiologist, etc.) in-network for my insurance?
- If any providers are out-of-network, what will that cost me?
- Can you provide a written estimate of all charges?
Frequently Asked Questions
Can I use Medicare at any hospital in an emergency?
Yes. In a true emergency, go to the nearest hospital that can treat you, regardless of whether it participates in Medicare. Medicare will cover emergency stabilization and treatment at any hospital. After you are stable, you may be transferred to a participating hospital if medically appropriate.
What is the difference between in-network and out-of-network at a hospital?
An in-network hospital has agreed to accept Medicare's payment rates and follow Medicare rules. An out-of-network hospital has not made this agreement and can charge you more. With Original Medicare, most hospitals are in-network. With Medicare Advantage, only hospitals in your plan's network are considered in-network.
If my hospital does not accept Medicare, can I still use my Medicare coverage there?
No, not for routine or planned care. A non-participating hospital is not required to accept Medicare payment. However, Medicare will still cover emergency care at any hospital, even if it does not participate in Medicare.
How do I know if my Medicare Advantage plan covers a specific hospital?
Check your plan's member handbook or visit your plan's website to search for hospitals. You can also call your plan's customer service number (on your insurance card) and ask whether a specific hospital is in-network for your plan.
What should I do if I receive a bill from a non-participating hospital?
Contact the hospital's billing department and explain that you have Medicare. Ask for an itemized bill and a breakdown of what Medicare paid and what you owe. If you believe the bill is incorrect, you can file a complaint with your state's insurance commissioner or contact Medicare directly for guidance.