Ask the Benefits Advisor
Primary Care Providers
Question: What is a primary care provider, and do I need one?
Answer: A primary care provider, or PCP, is a healthcare provider that can provide a wide range of medical services and help you get the care you need. Your PCP is who you see for regular check-ups, preventive care and common medical conditions.
A PCP is usually a doctor but can also be a physician assistant or nurse practitioner. They can refer you to a specialist if needed.
If you have a Medicare Advantage HMO plan, you’ll usually need to designate a PCP with your insurance company. If you’re in a Medicare Advantage PPO or Medigap plan, you generally don’t need to choose a PCP, though it’s a good idea to have one. Just make sure your PCP is a preferred provider, in network or takes Medicare, depending on the type of plan you have (see below).
Question: How do I change my PCP?
Answer: Not all plans require you to choose a PCP, so switching depends on the type of plan you have:
Medicare Advantage
If you’re enrolled in a Medicare Advantage HMO plan, your health insurance company will ask you to choose a PCP when you enroll. This doctor must be in your plan’s network and will help oversee your care and refer you to specialists if needed. If you want to change your PCP, you can select a new doctor from your plan’s network and contact your health insurance company directly, either by phone or online depending on your plan. Make sure the doctor is in your plan’s network and that they’re accepting new patients.
If you’re enrolled in a Medicare Advantage PPO plan, you usually don’t have to choose a PCP when you enroll, but it’s generally good to have one that you can go to for routine care. You can switch doctors anytime – just be sure to see doctors within your network to have the lowest out-of-pocket costs.
Medigap
If you’re in a Medigap plan, you can generally see any doctor you’d like, as long as they accept Medicare. You don’t have to choose a PCP, and you can switch doctors anytime. It’s a good idea to call the doctor’s office before your appointment to make sure they accept Medicare.
About licensed Benefits Advisors
Our licensed Benefits Advisors can give you personalized, unbiased guidance to help you make informed decisions about your healthcare. Their goal is to make sure you have the right plan for your needs. To speak with a licensed Benefits Advisor, please contact us to make an appointment.
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