Selecting a Primary Care Physician?
Key Takeaways
A Primary Care Physician is essential for managing and coordinating your care.
Customers that have HMO, POS and Catastrophic plans are required to have 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-network 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:
- Health Maintenance Organization (HMO)
- Point of Service (POS)
- Catastrophic plans
These plans also require the policyholder to get a referral from their PCP in order to see a specialist.
Find a local Medicare plan that fits your needs
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.
Are you eligible for cost-saving Medicare subsidies?
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.
