Kristin Kuhns thought she had her Medicare options figured out for the year. She’d picked her plan, and she’d found a doctor based on family recommendations — someone described as attentive and thorough. But when she called the clinic, she hit a wall.
“It seemed like if you had the special code word, you might get a different response, but if you didn’t it was the same answer every time – no, they’re not taking anyone,” Kuhns, 69, said.
She waited until her insurance took effect on Jan. 1, then joined what experts call a growing rush to secure primary care. Across the country, patients with Medicare, Medicaid, and private insurance alike are struggling to find doctors who will accept them — or who even exist in their insurer’s network.
Clinic Access Varies Widely by City
A “secret shopper” study led by Dr. Jane Zhu at Oregon Health and Science University found that only 77.5% of nearly 800 clinics across four major cities were accepting new Medicare patients. But access differed drastically by location. In Los Angeles, 97% of clinics accepted new patients. In New York, 93%. Chicago, 82%. But in Portland, just 35%.
Wait times told a similar story. Nationally, Medicare patients faced a median wait of two weeks to see a doctor. In Portland, it stretched to about two months, compared to eight days in New York and 11 days in Chicago.
“Where you lived really mattered,” Zhu said.
Doctors’ reluctance to take Medicare and Medicaid patients stems largely from reimbursement rates. Medicare sets the benchmark that private insurers use to determine their own payments, typically a percentage above the Medicare rate. This leaves public programs at a disadvantage, with Medicaid paying roughly 71% of what Medicare offers.
“It’s well-documented that physicians and clinicians get paid less for seeing a Medicare and particularly a Medicaid patient than they do for a patient that has commercial insurance,” Zhu said.
Family medicine and internal medicine doctors make up nearly a third of all physicians who opt out of Medicare entirely, according to a 2025 KFF analysis. There are about 154,750 family medicine doctors and 217,609 internal medicine physicians in the U.S. — meaning the shortage of willing providers is substantial.
Even private insurance isn’t solving the problem. Many plans list doctors in their directories who aren’t actually accepting new patients, a phenomenon known as “ghost networks.” A 2022 review of five major insurers found errors in 81% of provider directory entries. Nearly 18% of primary care providers in Medicare Advantage directories were ghosts, according to a separate study.
“The list of providers that plans give to their patients that say who is in network is often very inaccurate,” Zhu said.
Cost-sharing measures add another layer of difficulty. High-deductible plans can leave patients responsible for thousands of dollars before coverage kicks in. About one-third of working-age adults with private insurance are currently paying off medical debt, and 30% of them have delayed or avoided care because of cost.
“We may want to beat up on the public payers (Medicare and Medicaid) about how they may not reimburse enough, but we have individuals who have insurance through their employer and it’s still not affordable to people,” said Dr. Joe Betancourt, CEO of the Commonwealth Fund.
For Kuhns, the search eventually paid off. Her new doctor helped coordinate behavioral health support during her first visit, after Kuhns opened up about struggling with grief following her mother’s death. But she remains frustrated by the system’s complexity. “There are so many obstacles that it often seems like the aim isn’t to be helpful. The aim is to make it more difficult,” she said.
Reimbursement Rates Shape Doctor Decisions
Sophia Tripoli, managing director of health policy at Families USA, explained that Medicare’s payment structure serves as the baseline for the entire healthcare system.
“They take the Medicare rate and they increase the reimbursement as a percentage of Medicare,” Tripoli said. “They’re battling not over who’s providing the best care at the right price, but how much money can I extract out of the system. It creates this inflated payment on the commercial side.”
This dynamic leaves Medicaid providers even further behind. A May 2025 analysis in the journal Health Affairs found that Medicaid paid roughly 71% of what doctors could expect from Medicare in 2024, including just 69% for office visits. Even when doctors do accept Medicaid patients, the lower reimbursement rates make it financially challenging to sustain a practice.
Directory Inaccuracies Leave Patients Searching
Commercial insurers face similar access problems through ghost networks, provider directories that list doctors who aren’t actually accepting new patients.
Zhu, who worked on the secret shopper study, emphasized that these directories are supposed to help patients identify in-network doctors and understand associated costs. However, outdated listings mislead patients about availability, specialty, and network status.
In response, the Centers for Medicare and Medicaid Services introduced a new Plan Finder tool to help seniors identify doctors truly accepting new patients under Medicare Advantage. Despite its potential, a University of Michigan National Poll on Healthy Aging report found that only 15% of seniors have heard of the new search function.
For patients like Kuhns, who rely on ACA Marketplaces, the combination of high deductibles and inaccurate directories compounds the challenge. Tripoli pointed to plans with deductibles reaching $10,000, leaving many patients unable to afford care even when they locate a willing provider.
“You see high-deductible plans where patients on the private side are exposed to $1,000, $2,000, $5,000, even $10,000 deductibles,” Tripoli said. “Most people just don’t have that cash on hand in this economy to be able to foot a $5,000, even $1,000 deductible before their coverage kicks in.”
