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Primary care physicians (PCPs) are doctors who provide preventive care and treat common ailments. Primary care doctors who provide general care to Medicare beneficiaries can be:
There may be other kinds of health-care providers who can serve as primary care providers.
Medicare generally covers many primary care doctor services. Some coverage details depend upon how you choose to receive your Medicare benefits.
If you’re enrolled in Original Medicare (Part A and Part B): Medicare Part B (medical insurance) usually pays 80% for most doctor visits and a wide range of other medical care (after you meet your annual deductible). Part B generally covers preventive services and certain other medical services at no cost to you.
You don’t have to select a primary care physician near you to get your Part B benefits. However, you do need to use doctors who accept Medicare assignment if you want to get your maximum possible Medicare Part B benefits and control your out-of-pocket costs. Medicare assignment is an agreement between Medicare and the provider, such that the doctor will accept the approved Medicare amount as payment and not charge you more than any applicable deductible or coinsurance amount.
If you chose to receive your Medicare coverage from a Medicare Advantage plan: Different types of Medicare Advantage plans have different rules. The plan may require you to select a primary care physician from its network of participating health-care providers. You might need a referral from your primary care physician if you want or need to see a specialist. Check your plan rules for details.
There are several ways you might look for primary care doctors.
If you are enrolled in a Medicare Advantage plan, you can also call the plan’s Customer Service department to request a directory or assistance identifying primary care doctors near you. The Medicare Advantage plan’s directory may allow you research primary care physicians by location, specialty, and whether or not they are accepting new patients.
It’s generally a good idea to call the practice to confirm the information you have and schedule an appointment with the primary care doctor.
Finding the right primary care physician is important to help coordinate your health care. If you have questions about how to find a primary care physician near you, feel free to contact us and talk to one of eHealth’s licensed insurance agents. You can also use the Browse Plans button in this page, to find Medicare Advantage plans where you live.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.