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Selecting a Primary Care Physician?

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Written by:
Aaron Garcia

Key Takeaways

  • A Primary Care PhysicianA Primary Care Physician is a doctor that oversees and monitors your medical care under some plan types. PCPs also may be responsible for referrals to specialists. is essential for managing and coordinating your care.
  • If you have an HMO, POS, or Catastrophic plans, you’re required to choose a PCP.
  • In these plans, policyholders must receive referrals from their PCP to see a specialist.
  • Some plans require that you choose a PCP from a list of approved, in-networkIn-network refers to the doctors, hospitals and other providers that are inside of your provider network. A provider network is a group of providers that have agreed with your health insurance company to treat its customers. practitioners.

What is a Primary Care Physician?

Required under some health insurance plans, a primary care physician (PCP) is a policyholder’s main point of contact for their medical needs. Primary care physicians manage the majority of their patients’ care, from preventative services such as immunizations and screenings to diagnosing and treating illnesses.

The types of health insurance plans that require a PCP are:

These plans also require the policyholder to get a referral from their PCP in order to see a specialist.

Have questions about your Medicare coverage?

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What Services do Primary Care Physicians Provide?

A considerable advantage of having a PCP is that primary care physicians train to treat and diagnose conditions and illnesses across a broad spectrum. Although some primary care physicians specialize in certain areas.[i] The five most common types of PCP practices are:

  • Family medicine: These practitioners offer personalized care for everyone in your home, from the babies to the grandparents.
  • Internal medicine: Also called “internists”; these doctors are most familiar with treating patients that range from early adulthood to old age.
  • Pediatric medicine: These doctors care for patients from birth through childhood while monitoring key developmental milestones.
  • Internal Medicine-Pediatrics: Board certified in both Pediatrics and Internal Medicine; these practitioners can treat a wide range of patients.
  • OB-GYN: Short for Obstetrics and Gynecology, an OB-GYN specializes in women’s health. Many policyholders also choose to have a more broadly trained PCP in addition to their OB-GYN.

Do I Have a PCP?

If you don’t select a PCP at enrollment for an HMO, POS or catastrophic plan, the insurance company may choose one for you.

If you’re unsure whether you have a primary care physician, here are a few tips on finding out:

  • Check your insurance card. Some insurance companies include the name of the policyholder’s PCP on their cards for easy reference.
  • Call your insurance company. A quick call to customer service should answer most of your questions.

What Medicare coverage is right for my specific situation?

A drawing of a person selecting an option

How Do I Select My PCP?

The most important steps are to understand your network and choose a physician that’s in-network. You can find this information in the comprehensive lists of approved services and providers. If you’re not sure, know who to ask. Reach out to the benefits specialist at your job or contact GoHealth and speak to a licensed insurance agent.

Next, be sure to check with your preferred doctor’s office to make sure they are accepting new patients; if not, you’ll need to select another doctor and wait until your desired PCP is accepting new patients.

FAQs

No. HMO, POS and catastrophic plans require their policyholders to select a primary care physician, but PPO and EPO plans do not.
Not always. Like general practitioners, PCPs are usually trained broadly enough to care for a range of patients. Some, however, are focused on a specific area of care. PCPs can include the following types of practices:
  • Family medicine
  • Internal medicine
  • Pediatrics
  • Internal medicine-Pediatrics
  • OB-GYN
This information can sometimes be found on your health insurance card. If not, call your health insurance company.

Yes, as long as your desired doctor is:

  • Covered under your plan
  • Accepting new patients

Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.