Does Medicare require a referral to see a specialist?

With Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases, you do not need a referral to see a specialist. A referral is a note from your main doctor that sends you to another doctor.

A few things still matter:

• The specialist must take Medicare. Ask when you call to book.
• Ask if they accept assignment. That means they take Medicare's approved amount as full payment. If they do not, you may pay more.
• Ask if they take new patients. If you have not seen a doctor's group in the last 3 years, they may count you as a new patient.

In short: with Original Medicare, you can usually see any specialist who takes Medicare, with no referral.

Medicare Advantage plans set their own rules. The two most common types work differently.

• HMO plans: you usually choose a main (primary care) doctor. In most cases, you need a referral to see a specialist. Some services, like a yearly mammogram, do not need one. If you go outside the plan's network, you may pay the full cost, except for emergency or urgent care.
• PPO plans: you do not need to choose a main doctor, and you do not need a referral to see a specialist. Specialists outside the network usually cost more.

To compare the two, see HMO vs PPO Medicare Advantage plans.

Even without a referral, some care needs an order from your doctor. An order says what test or service you need and why.

• Tests like X-rays, MRIs, EKGs, and lab work are covered when your doctor orders them to find or treat a problem.
• Medical equipment for use at home, like a walker, needs an order from your doctor.
• Non-emergency ambulance trips need a written order that says the trip is medically needed.

The order can come from the doctor or other provider treating you, which can be your specialist.

With Original Medicare, after you meet the $283 Part B deductible for 2026, you pay 20% of the Medicare-approved amount for most specialist visits.

• If you have a Medigap plan: every plan pays some or all of your 20% share. Medigap works with Original Medicare, so you can see any specialist who takes Medicare.
• If you have Medicare Advantage: your plan sets its own copay for specialists. Check your plan's Evidence of Coverage. Check what your plan does if you skip a needed referral.
• If you have Medicaid too: Medicaid may pay your share. Ask your state Medicaid office.

1. Know which kind of Medicare you have: Original Medicare, or a Medicare Advantage plan (and which type).
2. Ask the specialist's office if they take Medicare, or your plan if you have Medicare Advantage.
3. If you have an HMO, get the referral first. Ask your main doctor to send it before your visit.
4. Ask if they accept assignment. This keeps your cost to 20% of the approved amount.
5. Bring a list of your medicines and any recent test results.

For more on finding doctors, see Medicare doctors, providers, and networks.

In short: check your plan type first; that tells you if you need a referral.