Access to Medicare Services

Medicare beneficiaries’ access to health care services is similar to that of privately insured people age 50–64. But, like privately insured individuals, they may face access problems, especially in geographic areas with provider shortages. Or they may need to travel long distances for specialty care.

Overall, the number of clinicians (physicians and other health professionals) who bill Medicare has increased over time, keeping pace with the growth in the number of Medicare enrollees. However, the mix of clinicians has changed, with a decline in primary care physicians and specialist physicians per Medicare enrollee and increases in other types of clinicians including advanced practice nurses and physician assistants. According to the Medicare Payment Advisory Commission (MedPAC), the number of primary care physicians billing Medicare declined between 2017 and 2022 causing a significant drop in the ratio of primary care physicians to Medicare enrollees. While the number of specialist physicians increased over this time period, Medicare enrollment grew more rapidly, so the ratio of specialist physicians to enrollees decreased. In contrast, the ratio of advanced practiced registered nurses and physician assistants to Medicare enrollees increased over this time.

The overwhelming majority of physicians take part in Medicare. Among those who do, nearly all agree to accept Medicare fee-schedule amounts as full payment. A small proportion of non-pediatric physicians opt out of Medicare and do not receive any Medicare payment, directly or indirectly, for any Medicare beneficiaries they treat.

According to MedPAC research, Medicare beneficiaries’ access to clinician services in 2023 was similar to, or better than, that of privately insured people age 50–64. In 2023, 65 percent of Medicare beneficiaries age 65 and older who needed an appointment for illness or injury during the prior 12 months reported that they never had to wait longer than they wanted, compared with 55 percent of privately insured people age 50–64. Among Medicare beneficiaries age 65 and older seeking an appointment for routine care, 49 percent never had to wait longer than they wanted, compared with 37 percent of privately insured people ages 50‒64.

However, for people looking for a new primary care provider, the likelihood of encountering difficulty has increased over time for both groups. Among Medicare beneficiaries age 65 and older who were looking for a new primary care provider, 23 percent reported a large problem finding one in 2023, up from 14 percent in 2019. Among privately insured people age 50‒64 who were looking for a new primary care provider, 33 percent had a large problem finding one in 2023, compared with 17 percent in 2019.

Reports of access problems in some geographic areas appear to reflect general provider shortages (that is, not just in Medicare). In some cases, beneficiaries must travel long distances for certain specialty care. If MedPAC analyses identify a national problem, a broader discussion of workforce and payment policies should take place. Even if the problem is localized, it may merit the development of policies to improve beneficiaries’ ability to receive appropriate, high-quality services.

Mobile Integrated Healthcare and Treat and Refer programs have been found to be successful in helping to bring services to rural communities, some using individual physicians in partnership with paramedics. These programs are covered through Medicaid and have been proven successful in supporting rural residents' access to care while also reducing emergency room and hospital visits. Medicare has experimented with payment in this area but does not currently permit reimbursement for these programs.