Can My Family Keep Our Primary Care Doctor?

Individual and Family

Can My Family Keep Our Primary Care Doctor?

Published on April 10, 2018


One of the first things that most people ask about a new health insurance plan is if they can keep their current primary care physician. Children, adults, and even seniors may develop a good relationship with a doctor such as a pediatrician, family doctor, or internal medicine doctors (three of the most common types of primary care physicians). These familiar physicians have had time to understand their patient’s medical history and personality.  It’s easy to understand why people might feel reluctant to switch doctors when it comes to getting a new individual or family health insurance plan. However, your ability to keep your primary care doctor may depend upon your new insurance plan, the doctor, and your own preferences.

How to tell if you can keep your primary care doctor on your new health insurance plan

Before jumping into how you might be able to keep your primary care doctor, let’s look at some popular types of health insurance plans:

  • HMO: With an HMO, you must almost always visit a doctor on the plan network in order to get non-emergency services covered.  You may also need your primary care doctor to give you a referral in order to get a specialist visit covered.  According to Kaiser Foundation research, HMOs cover over 30 percent of people in the United States who have health insurance.
  • PPO and HMO/POS: With a PPO or HMO/POS, you generally have to pay higher deductibles or copays to access healthcare services outside of the plan network. With a PPO, you generally don’t need a referral from a primary care doctor to get a covered visit to a medical specialist; however, you may with an HMO/POS.

HMOs and PPOs cover most people in the United States. An HMO/POS is a sort of hybrid of an HMO and PPO. These common kinds of medical plans in the United States all utilize plan networks to help control costs for both the insured people and the insurance company. The insurance company negotiates prices with network medical providers as part of their agreement. Generally, plan members accept some network restrictions in exchange for lower premiums and out-of-pocket costs.

  • If you want to keep your primary care doctor, you first should find out if this doctor has joined the network as one of their care providers. Thus, these are important things for you to understand.If you join a PPO or HMO/POS, you may still have the option to pay more to stay with your primary care physician.
  • With an HMO, you usually will not be able to get covered services from non-network doctors unless you see that doctor because of a medical emergency.
  • To make sure that you can still keep your doctor and keep your costs as affordable as possible, you will want to choose a plan that includes your primary care doctor within the plan’s network.

Where to check networks for your primary care doctor

You will probably find your primary care physician on some local networks. However, a few doctors don’t belong to plan networks or only belong to a select few. In some cases, you may be able to contact the doctor’s office and ask if they would consider joining the new network.
However, if you have decided upon a plan that doesn’t include your current primary care doctor, you will probably have to find a new doctor, pay extra for out-of-network services, or not have your care from that doctor covered at all. If you do decide a new plan that will cause you to switch primary care doctors, you should begin by having your medical history transferred to the new office. Typically, your new provider can give you a form to fill out to complete this task.
You can search for local health insurance plans here on eHealth simply by specifying the kind of medical insurance you want and your ZIP code. Once you have narrowed down your search, you can check the list of providers to see if you can find your primary care doctor. If you can’t find your primary care physician on the first plan you check, you should find plenty of other options to consider.

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