# Medicare Desert Map: The Cities and States Where Doctors Are Turning Away Medicare *Our analysis of 3.1 million providers reveals a 33-point gap between the best and worst cities for Medicare acceptance* Source: https://ourhealthnetwork.com/insights/medicare-desert-map-cities-worst-acceptance Author: OurHealthNetwork Editorial Team Published: 2026-03-26 Last updated: 2026-03-26 Reading time: 8 minutes ## Summary Analysis of CMS Medicare enrollment data for 3.1 million healthcare providers, mapping acceptance rates by state, city, and specialty. Maryland, Baltimore, and psychiatry emerge as the biggest trouble spots. ## Nearly 1 in 6 Doctors in Maryland Do Not Accept Medicare. Here Is Where Else the Program Is Failing Patients. Medicare covers 67 million Americans, making it the single largest health insurance program in the country. Most people assume their Medicare card will be accepted by any doctor they choose. That assumption is wrong in a growing number of cities and states. We analyzed CMS Medicare enrollment data for 3.1 million healthcare providers to measure exactly how many accept [Medicare](/insurance/medicare) patients, how many handle cases individually, and where the gaps are widest. The national picture looks reassuring at first glance. But zoom into specific states, cities, and specialties, and the cracks become impossible to ignore. 94.1% National Acceptance 84.5% Maryland (Worst State) 65.6% Baltimore (Worst Metro) 8.1% Psychiatry Opt-Out Rate ## The National Numbers: 94.1% Acceptance Masks Deep Gaps Of the 3,107,274 providers in the CMS dataset, 2,925,436 accept Medicare outright. That is 94.1% of the total. Another 181,837 providers (5.9%) evaluate Medicare patients on a case-by-case basis, which in practice often means refusing patients with complex conditions or lower-reimbursement procedures. On the surface, 94.1% sounds solid. But that number hides enormous variation. The gap between the best and worst states spans 12.2 percentage points. The gap between the best and worst major cities is more than 33 points. And in certain specialties, the numbers fall off a cliff entirely. ## The Bottom 15 States: Maryland Stands Alone Maryland's 84.5% acceptance rate puts it in a category of its own. No other state comes within 6 points. The state's unique all-payer hospital rate-setting system, which caps what hospitals can charge all insurers including Medicare, creates an unusual reimbursement environment that appears to push providers toward selective participation. Vermont, Washington D.C., New York, and Rhode Island cluster between 91% and 92%, forming a second tier of states where Medicare patients face meaningful access barriers. The pattern skews heavily toward the Mid-Atlantic and Northeast, where cost of living is high and private insurance reimbursement rates create a wider gap between what Medicare pays and what providers could earn from commercially insured patients. Bottom 15 States by Medicare Acceptance Rate National average: 94.1% (dashed line) 80% 85% 90% 95% 100% 94.1% avg width = (84.5-80)/20*530 = 119.3 --> Maryland 84.5% width = (91.2-80)/20*530 = 296.8 --> Vermont 91.2% width = (91.3-80)/20*530 = 299.5 --> D.C. 91.3% width = (91.5-80)/20*530 = 304.8 --> New York 91.5% width = 304.8 --> Rhode Island 91.5% width = (92.3-80)/20*530 = 326.0 --> Nevada 92.3% width = (92.9-80)/20*530 = 341.9 --> Massachusetts 92.9% width = (93.0-80)/20*530 = 344.5 --> New Jersey 93.0% width = (93.1-80)/20*530 = 347.2 --> Connecticut 93.1% width = (93.2-80)/20*530 = 349.8 --> Colorado 93.2% width = (93.3-80)/20*530 = 352.5 --> Arizona 93.3% width = (93.4-80)/20*530 = 355.1 --> California 93.4% width = (93.5-80)/20*530 = 357.8 --> Texas 93.5% width = (93.6-80)/20*530 = 360.4 --> Florida 93.6% width = (93.7-80)/20*530 = 363.1 --> Washington 93.7% At the other end of the spectrum, Pennsylvania leads the country at 96.7%, followed by Mississippi (96.2%), South Dakota (96.1%), Wisconsin (96.1%), and Missouri (95.9%). These states share a common thread: lower costs of living, fewer concierge or cash-pay medical practices, and health systems that depend heavily on Medicare revenue to stay afloat. "Seven of the ten worst states for Medicare acceptance sit in the Mid-Atlantic or Northeast corridor. The concentration is not a coincidence. It reflects a regional healthcare economy where private-pay patients and concierge medicine have become viable alternatives to government reimbursement." ## Metro Areas: Baltimore Tops the List, But Texas Cities Surprise The city-level data tells a sharper story than the state averages. Baltimore's 65.6% acceptance rate is by far the worst among major metro areas. More than one in three providers in Baltimore evaluate Medicare patients on a case-by-case basis. Combined with Maryland's statewide problem, Baltimore Medicare patients face some of the most restricted access in the country. The Bronx stands out even more starkly: only 55.6% of its 7,770 providers accept Medicare outright. While not classified as a "major metro" in the same way, it represents one of the densest concentrations of Medicare-age residents in the nation. More than 4 in 10 providers there make case-by-case decisions about whether to see Medicare patients. Texas cities appear unexpectedly high on the problem list. Dallas (87.8%) and Fort Worth (88.9%) both fall well below the national average, and Austin (90.6%) joins them below 91%. For a state where overall costs are moderate, the Texas metro numbers suggest that rapid growth and an influx of privately insured tech workers may be pulling providers away from Medicare participation. Rank Metro Area Acceptance Rate vs. National 1 Baltimore, MD 65.6% -28.5 2 Dallas, TX 87.8% -6.3 3 Fort Worth, TX 88.9% -5.2 4 Austin, TX 90.6% -3.5 5 Atlanta, GA 91.0% -3.1 ... 11 Philadelphia, PA 96.8% +2.7 12 Hartford, CT 97.0% +2.9 13 Milwaukee, WI 97.1% +3.0 14 Cleveland, OH 98.2% +4.1 15 Rochester, MN 98.7% +4.6 Rochester, Minnesota, home to the Mayo Clinic, posts the highest acceptance rate among major metros at 98.7%. Cleveland (98.2%), Milwaukee (97.1%), Hartford (97.0%), and Philadelphia (96.8%) round out the top five. These cities share a common trait: large, established health systems with deep Medicare patient pools and institutional cultures built around accepting all comers. ## The Specialty Crisis: Psychiatry, Dentistry, and Mental Health The most alarming numbers in this dataset do not come from geography. They come from specific medical specialties. And the worst-performing specialty is not even close. Dentists accepting Medicare sit at just 32.7%. This largely reflects the fact that traditional Medicare (Parts A and B) does not cover routine dental care, so most dentists have little financial reason to enroll. But the numbers for mental health providers tell a more troubling story about access to care that Medicare is supposed to cover. [Psychiatrists](/psychiatrist) nationally accept Medicare at 92.0%, but that number is misleading. Among physicians who have formally opted out of Medicare entirely, 39% are psychiatrists. According to [KFF's analysis of Medicare opt-out data](https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/), psychiatry's 8.1% opt-out rate is the highest of any medical specialty. In Maryland, only 77.2% of psychiatrists accept Medicare. 8.1% Psychiatry Opt-Out Rate Highest of any medical specialty 1.2% National Physician Opt-Out Rate 12,244 physicians total Mental health counselors fare even worse at 72.8% acceptance nationally, and marriage and family therapists sit at 71.9%. For patients relying on Medicare to access mental healthcare, these numbers represent a real barrier. Finding a psychiatrist or therapist who accepts Medicare can require weeks of phone calls and long wait times, particularly in states like Maryland and New York. On the other end, surgical and procedural specialties post near-universal acceptance. [Hematology-oncology](/oncologist) leads at 98.6%, tied with thoracic surgery and colorectal surgery. [Cardiologists](/cardiologist), [gastroenterologists](/gastroenterologist), [pulmonologists](/pulmonologist), and [urologists](/urologist) all exceed 96%. These specialties depend on Medicare volume because their patient populations skew older, and the reimbursement for procedures, while lower than private insurance, remains sufficient to sustain a practice. ## The Money Problem: 33% Payment Decline Since 2001 33% Decline in Medicare Physician Payment Since 2001 Adjusted for inflation in practice costs. Source: [AMA](https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-payment-schedule) The root cause behind every number in this analysis comes back to money. Medicare physician reimbursement has declined by roughly 33% since 2001 when adjusted for the rising cost of running a medical practice. While the costs of malpractice insurance, staff salaries, electronic health records, and office rent have all climbed, Medicare payment rates have remained essentially flat or grown at a fraction of inflation. This creates a straightforward economic calculation for providers. An [internist](/internist) in Baltimore who could see a commercially insured patient for $180 gets roughly $90 from Medicare for the same visit. A [dermatologist](/dermatologist) in New York performing a procedure that pays $400 through private insurance might receive $160 from Medicare. In high-cost metros, that gap becomes unsustainable for solo and small-group practices. The 12,244 physicians who have formally opted out of Medicare represent just 1.2% of all physicians. But formal opt-out understates the problem. Many more providers remain enrolled but limit how many Medicare patients they see, or they evaluate acceptance on a case-by-case basis. The 5.9% case-by-case rate nationally likely masks significant de facto non-participation. ## Small Towns Tell a Different Story While major metro areas show the most variation, small and rural communities often post near-perfect acceptance rates. Cities like Lehighton, Pennsylvania; Colville, Washington; and East Stroudsburg, Pennsylvania all show 100% Medicare acceptance among their providers. This is not because rural providers are more generous. It is because in many small towns, Medicare patients make up 40% or more of a practice's total patient volume. Refusing Medicare in a community where most residents are over 65 would be refusing to have a practice at all. The family medicine physicians and internists who serve these communities depend on Medicare revenue in ways that urban specialists with large commercially insured panels simply do not. The irony is striking: the communities with the fewest healthcare options often have the best Medicare acceptance, while the cities with the most providers give patients the hardest time finding one who will take their coverage. ## Specialties in the Middle: Where Access Varies by Location Some specialties sit near the national average but show enormous geographic variation. [Orthopedic surgeons](/orthopedic-surgeon) accept Medicare at roughly 95% nationally, but in high-cost coastal markets that rate can dip below 90%. [Endocrinologists](/endocrinologist) and [radiologists](/radiologist) track close to 96% or above nationally, though urban centers with strong private-pay populations show lower numbers. [OB-GYNs](/obgyn) present an unusual case. Their Medicare acceptance rate is relatively high, but their Medicare patient volume tends to be low because most of their patient base is younger. [Geriatricians](/geriatrician), who treat almost exclusively older patients, accept Medicare at very high rates because their specialty only makes financial sense within the Medicare system. ## What This Means for Medicare Patients If you are a Medicare beneficiary, your ability to find a doctor who accepts your insurance depends on three factors: where you live, what kind of doctor you need, and whether you need mental healthcare. Living in Pennsylvania, Mississippi, South Dakota, or Wisconsin gives you the best odds. Living in Maryland, Vermont, or parts of New York puts you at a significant disadvantage. Needing a surgeon or procedural specialist means near-universal acceptance. Needing a psychiatrist or mental health counselor means a much harder search. The 94.1% national number is real, but it does not describe anyone's actual experience. Healthcare is local, and the Medicare acceptance landscape varies so dramatically from one city to the next that national averages obscure more than they reveal. A Medicare patient in Rochester, Minnesota, lives in a fundamentally different healthcare environment than a Medicare patient in Baltimore or the Bronx. For the 67 million Americans on Medicare, these numbers are not abstract. They determine whether a phone call to a new doctor ends with an appointment or with the words "we are not accepting Medicare patients at this time." ### Methodology This analysis uses [CMS Medicare provider enrollment data](https://data.cms.gov/provider-data/) for 3,107,274 healthcare providers. "Accepts Medicare" includes providers with a participation status of "Y" (accepting assignment). "Case-by-case" includes providers listed as evaluating Medicare assignment on a per-claim basis. Opt-out data is sourced from CMS records and KFF analysis. Metro area analysis includes cities with 5,000 or more listed providers. Payment decline figure is sourced from AMA analysis of Medicare Physician Fee Schedule updates adjusted for practice cost inflation. ## Tags Medicare, Medicare acceptance, Medicare desert, physician payment, healthcare access ## Related articles on OurHealthNetwork - https://ourhealthnetwork.com/insights/telehealth-adoption-by-state - https://ourhealthnetwork.com/insights/gender-gap-medicine-specialties - https://ourhealthnetwork.com/insights/insurance-network-comparison-by-state ## About this article This article is part of OurHealthNetwork's insights collection. We are an independent healthcare data platform aggregating federal datasets (CMS, FDA, CDC) to inform patients and caregivers. See https://ourhealthnetwork.com/methodology for our editorial approach and https://ourhealthnetwork.com/data-sources for source datasets.