In the past, people relied on family doctors for everything from broken bones and the common cold to the delivery of babies. Family practitioners knew the medical history of the entire family because they treated both the children and the parents.

Today, many doctors are specialists, focusing on the care of specific bodily systems. But general practitioners, internal medicine doctors and family medicine doctors are still carrying on the tradition of family doctors. Here’s an overview of how primary care physicians (PCP) work, which plans require one, and what to look for when finding a PCP.

Introduction to primary care

In the intricate landscape of healthcare, primary care serves as the foundational cornerstone. It is the point of entry into the vast world of medical services, where individuals embark on their journey towards optimal health. In this section, we will unravel the significance of primary care, exploring its role as the central hub for preventive measures, early intervention, and the maintenance of overall well-being.

What is a primary care physician?

Many health insurance plans today, especially HMO (Health Maintenance Organization) plans, require members to choose a primary care physician (often called a PCP). Since major provisions of the Affordable Care Act (also known as “Obamacare”) were first rolled out in 2010, the popularity of HMO-style plans has increased. As a result, more consumers are choosing primary care doctors and getting a taste of the traditional family medicine model.

If you’re in an HMO, a primary care doctor will typically be your first point of contact for all your health issues. When you need care from a specialist, your primary care physician generally refers you to specialists within your plan’s provider network.

Which doctors qualify as primary care physicians?

There are many specialties in medicine, but typically only four qualify as PCPs. These include:

• Family practice or general practice doctors: A family or general practitioner is qualified to care for the entire family. Family or general practitioners can be board-certified and have training in a variety of areas including Obstetrics and Gynecology, Pediatrics, Internal Medicine, or Psychiatry. Doctors of this sort were more common in years past but can still be found to treat the entire family.
• Internal medicine doctors: Also known as internists, internal medicine doctors are specifically trained in diagnosis and treatment. Unlike family practice doctors, internists usually only see adult patients. An internist is not a surgeon. There are several sub-specialties an internist can have. Some may specialize in a particular organ, like the lungs or the kidneys; or a particular disease, like diabetes; or a particular age group, like the elderly.
• Pediatrics: A pediatrician specializes in the care of children. Most treat children from birth until adolescence., and some can have sub-specialties such as surgery or pediatric cardiology. Pediatricians only serve as primary care doctors for children. Please note that health plans may have rules on age limits for patients treated by pediatricians. Age limits may range from 18 to 21 years of age. Check with your plan for specific details.

Importance of having a primary care doctor

Having a primary care doctor is akin to having a trusted guide on your healthcare journey. They are your first point of contact, your advocate for wellness, and your partner in managing your health. In this section, we will delve into the profound importance of having a primary care physician. From preventive care to the coordination of complex medical needs, your primary care doctor plays a pivotal role in safeguarding your health. Join us as we explore the many reasons why having a primary care doctor is a fundamental step towards achieving and maintaining your best possible health.

Benefits of having a primary care doctor

Having a PCP is beneficial because they’re typically your first point of contact when you have a concern. They have a bird’s eye view of your entire health history since they keep a running record of your care. They also help make sure there are no harmful interactions between your medications.

For example, a routine health exam may uncover conditions such as high blood pressure or even hormonal imbalances due to glandular problems. Health problems like these can go unnoticed by the patient for years and could result in serious chronic health issues. Annual exams with your PCP may guide you toward healthy lifestyle habits and help you catch serious conditions early, when they are more easily treated. One of the most important jobs of a primary care doctor is preventive care: keeping you from getting sick in the first place. Seeing your PCP every year reduces the likelihood that you’ll need expensive specialty care later.

Your PCP can also collaborate with other professionals and refer you to a specialist as needed. They help you stay in good health and even prevent medical issues since they may be the first to notice if something’s wrong. Your PCP can also recommend lifestyle changes to mitigate risk factors and order preventative testing.

When might you need a primary care doctor?

Having a primary care physician (PCP) is an important part of managing your health. PCPs serve as a home base for your medical needs. You’ll likely see a primary care doctor (PCP) for many common complaints, such as a headache, flu, or infection. You’ll also see a PCP for routine checkups and screenings.

They may even manage chronic conditions, like diabetes, high blood pressure, and depression. Unlike specialists, a PCP is a generalist who cares for a wide range of medical problems.

How to find a primary care doctor

Choosing a doctor can be challenging. You might not want to just pick a name out of the phone book. If your insurance plan requires you to choose a PCP, however, you may want to take time to research your options. Here are some ideas to get you started:

• Your health insurance plan. Your health insurance plan may keep an online list of network primary care doctors who are accepting new patients. Choosing a PCP is often the first step in seeking treatment under an HMO plan. PCPs will handle any referrals to specialists you need.
• Personal referrals. People often ask their friends, families, and co-workers for referrals to primary care physicians. If someone you respect and trust has a positive experience with a doctor, it’s possible you may like that particular physician.
• Referrals from your current physician. If you are moving to a new area, you could ask your current physician to help you find a PCP in your new neighborhood, assuming you’re still going to be covered under the same health insurance plan.
• Hospital access. It is common for hospitals to offer a referral service that can provide you with the names of staff doctors who meet certain criteria you may be seeking, such as specialty, gender, experience, and location.

Once you’ve found a primary care doctor you like, always check the network provider list first before

switching plans in the future. Keep in mind that each plan has different provider networks, so if it’s important to you to keep your PCP, check with the plan you’re considering. A licensed insurance agent at eHealth can help you find plan options that include your primary care doctor. We know it can be difficult to sort through all the different types of health plans. If you’d like help, simply call the number on this page for personalized assistance.

Researching local healthcare providers

Researching local healthcare providers is a vital step in managing your health effectively. It allows you to make informed choices about who will be responsible for your medical care. In this section, we will walk you through the process of conducting thorough research on healthcare providers in your area. From primary care physicians to specialists, we’ll provide valuable insights on where to look for information, what criteria to consider, and how to assess the quality of care offered. By the end of this guide, you’ll be equipped with the knowledge and tools needed to make confident decisions when it comes to your healthcare providers. Your health is too precious to leave to chance, so let’s embark on this journey to ensure you receive the best possible care.

Checking credentials and reviews

Selecting the right primary care doctor is a crucial decision that can significantly impact your health and well-being. Before making this choice, it’s essential to gather as much information as possible to ensure you’re in capable hands. In this section, we’ll explore the significance of checking credentials and reading reviews when choosing your primary care doctor.

Credentials provide a window into a physician’s qualifications, education, and experience, allowing you to assess their competence. On the other hand, reviews offer insights from real patients who have firsthand experience with the doctor’s care. By combining these two aspects, you can make an informed decision that aligns with your healthcare needs.

Navigating insurance coverage

When you’re enrolled in an HMO plan, the importance of choosing a primary care physician (PCP) within your network cannot be overstated. Here’s why network doctors matter:

• Cost Considerations: In HMO plans, stepping outside the network for your PCP can result in significantly higher medical expenses. In some instances, you might even be responsible for covering the entire cost of care. While PPO plans operate differently, typically with increased costs for non-network doctors, HMOs require you to stay within the network for your primary care.
• Coverage Assurance: HMO plans often stipulate that your primary care doctor must be in-network for comprehensive coverage. While exceptions may exist, allowing coverage for urgent or emergency care with non-network providers, your routine primary care needs should align with the network.

To ensure your PCP is in-network, follow these practical steps:

1. Consult Your Plan: Every health plan maintains a list of network providers, and this is your first point of reference. Contact your health plan directly to verify whether your chosen PCP is covered under your policy. This step is critical in avoiding unexpected expenses.
2. eHealth Guidance: If you have any doubts about whether an HMO or PPO plan suits your specific needs, don’t hesitate to reach out to an eHealth licensed insurance agent. They can provide expert insights, clarify the differences between these plan types, and help you determine which one aligns best with your healthcare requirements.

Navigating insurance coverage might seem intricate, but it’s a crucial part of the process when searching for a primary care physician. By taking the right steps and ensuring your PCP is in-network, you’ll not only optimize your coverage but also pave the way for a smoother and more cost-effective healthcare journey. Your health and financial well-being deserve this careful consideration.

Considerations for choosing a primary care doctor

Maybe you’re searching “how to get a primary care doctor near me.” Or you may be considering how to get a new primary care doctor.

So, what should you look for in a PCP? Since everyone wants different things in a medical provider, it will depend on your situation and needs.

However, there are a few things to consider when it comes to choosing a primary care doctor:

• Credentials and experience: check qualifications and board certifications. Learn more about their experience with specific conditions or procedures.
• Logistical considerations: make sure the location of the office and their hours align with your needs.
• Choose an in-network provider: Many health insurance plans have lists of doctors or clinics that are “in-network.” This just means that they’ve worked out a relationship with the provider, and your care will be covered. You may have to pay out of pocket if a provider is out-of-network, so you should confirm with both insurance and the provider whether they’re in-network with your plan.
• Do research online or through word of mouth: Chances are, others in your community have gotten medical care from your potential providers. Look for reviews online or ask friends or family about their experiences when researching PCPs.
• Make sure the provider fits your needs: Some PCPs may have areas of interest or expertise that match your medical needs more than others. You may also need a PCP that does telehealth or is located closer to your home.

Transitioning to a new doctor

Transitioning to a new doctor can seem daunting, but with the right approach, it can be a smooth and seamless process. Here’s a step-by-step guide to help you navigate the transition:

1. Research and Selection: Start by researching potential doctors in your area who meet your healthcare needs and preferences. Consider factors such as location, specialties, and patient reviews. Once you’ve chosen a new doctor, contact their office to schedule an appointment.
2. Transferring Medical Records: Before your first appointment with your new doctor, arrange to have your medical records transferred from your previous healthcare provider. This ensures that your new doctor has access to your complete medical history, including past treatments, medications, and any relevant test results.
3. Communicating Your Health History: During your initial appointment with your new doctor, take the time to discuss your health history in detail. Be sure to mention any chronic conditions, past surgeries, allergies, and family medical history. Providing this information helps your new doctor gain a comprehensive understanding of your health needs and develop an appropriate treatment plan.
4. Establishing a Preventive Care Plan: Prevention is key to maintaining good health, so work with your new doctor to establish a preventive care plan tailored to your individual needs. This may include scheduling regular screenings, vaccinations, and wellness exams to detect and address any health issues early on.
5. Building a Relationship: Building a strong relationship with your new doctor is essential for effective healthcare management. Be open and honest about your concerns and preferences, and don’t hesitate to ask questions or seek clarification on any aspects of your care. Establishing clear communication and trust with your new doctor lays the foundation for a successful and collaborative healthcare partnership.

By following these steps, you can transition to a new doctor with confidence, knowing that you’re taking proactive steps to prioritize your health and well-being. Remember, your new doctor is there to support you on your healthcare journey, so don’t hesitate to reach out if you have any concerns or need assistance along the way.

FAQs about finding a primary care doctor

What is a primary care doctor?

A primary care doctor, also known as a primary care physician (PCP), is your main healthcare provider who oversees your general health and well-being. They are often the first point of contact for any health concerns or medical issues you may have. Your primary care doctor plays a crucial role in coordinating your overall healthcare, from routine check-ups and preventive care to managing chronic conditions and referring you to specialists when needed. Building a trusting relationship with your primary care doctor is key to receiving personalized and comprehensive healthcare tailored to your individual needs.

How do I find a primary care doctor in my area?

Finding a primary care doctor in your area is easier than you might think. Here are a few simple steps to help you locate the right primary care doctor for you:

1. Check with Your Insurance: Start by checking your health insurance provider’s website or contacting their customer service department to find a list of primary care doctors in your network. Choosing a doctor within your insurance network can help minimize out-of-pocket costs.
2. Ask for Recommendations: Reach out to friends, family members, or colleagues who live in your area and ask if they have any recommendations for primary care doctors. Personal referrals can provide valuable insights into the quality of care and bedside manner of potential doctors.
3. Use Online Directories: Utilize online directories and healthcare provider databases to search for primary care doctors in your area. Websites like eHealth Insurance, Healthgrades, Zocdoc, and the American Academy of Family Physicians’ Find a Doctor tool allow you to search for doctors based on location, specialty, and patient reviews.
4. Consider Location and Convenience: Take into account the location and office hours of potential primary care doctors. Choose a doctor whose office is conveniently located near your home or workplace and offers appointment times that fit your schedule.
5. Schedule a Meet-and-Greet: Once you’ve narrowed down your list of potential primary care doctors, consider scheduling a meet-and-greet appointment to get to know them better. This initial consultation allows you to ask questions, discuss your healthcare needs, and assess whether the doctor is the right fit for you.

What kinds of plans typically require members to choose primary care physicians?

Consumers covered under any type of health insurance plan may choose a primary doctor as their main point of contact. But only people enrolled in Health Maintenance Organization (HMO) plans are typically required to choose a specific doctor as their primary care physician.

People enrolled in Preferred Provider Organization (PPO) plans, POS (Point of Service) plans, or EPO (Exclusive Provider Organization) plans typically aren’t required to officially designate a primary care physician. And, if you’re in a PPO plan, you don’t need a referral before seeing specialists.

Since 2014, the popularity of HMO-style plans has increased significantly, while the popularity of PPO-style plans has decreased. This means that more and more Americans are being required to choose primary care doctors.

How can I get help finding a plan that covers my primary care doctor?

Now that you have a better understanding of why it’s so important to find a primary care doctor, you might have questions on how to find coverage that helps lower your medical costs. Or, you may have a primary care doctor you love but would like to switch plans. If you’d like help making sure your new plan includes your PCP, we can help.

eHealth’s team of trusted and expert licensed insurance agents can go over your options to help you find coverage that may work for you. Enter your zip code where requested on this page to see personalized individual and family health plans, or browse health insurance plans by state. As always, you can call the number on this page to speak with someone directly.