Is My Primary Care Doctor Important?

Individual and Family

Is My Primary Care Doctor Important?

Published on April 02, 2018

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You’ve probably heard “primary care doctor” or “primary care physician” (PCP) tossed around before, but maybe you’ve never gotten a clear definition or understood what role this type of doctor plays in your personal health. Let’s look at why a primary care doctor can be extremely important, how to choose one, and what kinds of plans require a primary care doctor.

What is a primary care doctor?

It may not be obvious, but the way healthcare works has changed quite a bit. Nowadays we have all sorts of specialists to deal with specific problems divided by gender, organs, age, etc. But families used to have family doctors who dealt with everything. These family doctors knew the medical history of all the adults and children in the family, and they were consulted for any medical concerns.
A primary care doctor greatly resembles that tradition of having one medical practitioner handle all basic medical needs. Types of doctors that commonly serve as primary care practitioners:

  • Family practice of general practice doctors. These doctors are similar to traditional doctors that treated entire families. They are qualified to deal with all ages and genders, and are trained in a variety of medical subjects.
  • Internal medicine doctors. Internal medicine doctors are generally more geared towards the medical care of adults, and they can diagnose and treat disease with medicine. Some internists have sub-categories they specialize in such as a particular organ, disease, or age group.
  • If you have children on your family health insurance plan, they will probably have a pediatrician as their primary care provider. Oftentimes, pediatricians treat children from birth to adolescence. In the first few years of your child’s life, doctor’s visits will probably be common, since well-child visits are suggested in order to track early development. The American Academy of Pediatrics suggests the following schedule for well-child checkups:
    • 3-5 days after birth
    • 1 months
    • 2 months
    • 4 months
    • 6 months
    • 9 months
    • 12 months
    • 18 months
    • 24 months
    • 30 months
    • 3 years old
    • 4 years old

Keep in mind that your pediatrician may have a slightly altered schedule, so make sure to check with him or her for specifics, and do not rely on this article for medical advice.

Do I have to choose a primary care doctor?

Whether or not you need to choose a primary care doctor will depend on what type of health insurance plan you choose. If you have a Health Maintenance Organization (HMO) plan, you will typically need to have a primary care physician, since any visits to specialists must come with a referral from a PCP.
Some key things to know about an HMO plan:

  • An entire network of healthcare providers agrees to offer you its services, but you have to select a primary care provider (PCP) who coordinates all of your health services and care.
  • HMOs usually offer coverage for most types of preventive care, including specialist visits, but in most cases, specialist visits can only happen with a referral from your PCP. Additionally, you will pay copayment fees for every non-preventive medical visit, and you may have an annual deductible.
  • HMOs are usually best suited for individuals and families that want to save money and do not mind using a limited provider network.

Each plan has its own terms and limitations, so be sure to check the official plan documents to understand how that specific plan works.  This article is only for general education.

How to choose a primary care doctor

Choosing a primary care doctor is an incredibly personal decision. Once you have found one, you might not want to lose him or her despite a change in health insurance. To help with this situation, eHealth has a “Find Doctors” tool that allows you to look for health insurance plans that will allow you to keep going to your primary care doctor.
If you are looking for a new primary care doctor, you can use our “Find Doctors by State” tool. This will show you doctors in your area. Some other ways you can find a new primary care doctor include:

  • Personal referrals
  • Information provided by your health insurance plan
  • Referrals from current physician
  • Referrals from hospitals

Each insurance plan periodically updates its list of in-network doctors and providers, so always double check coverage with both the plan and the doctor or provider before incurring medical expenses.

What are some of the benefits of having a primary care doctor?

Your health insurance plan may not require you to choose a primary care provider (PCP), but there’s still quite a few good reasons to choose one anyways. Some examples of why you may want to find a primary care doctor:

  • Medical history. Hospitals keep medical records, so if you often go to doctors within the same network, there’s probably a file of your medical history in their system. But having one health practitioner who knows your medical history, and knows you personally might help when it comes to keeping you healthy, and finding the source of any health problems you might be experiencing.
  • Health plan. Similarly, having a doctor you’re familiar with can help making a health plan easier on both you and your medical practitioner. If you want to create a long term plan for maintaining a healthier lifestyle, having consistency and familiarity with your provider might be a good idea.
  • Annual Check-up. Some health insurance plans come with an annual check-up that doesn’t require a copayment from you. But even if your plan does require a copayment, going to the doctor every once and awhile just to check in on your health isn’t a bad idea. If you have a primary care doctor who you go to for every check-up throughout the years, they can check back in with you about any problems you discussed with them previously. Going to a primary care doctor might also help you feel more comfortable to ask questions and share any concerns that you wouldn’t be as comfortable to bring up in front of a doctor you’ve never met before.

This article is for general information and should not be relied on as medical advice.  Check with a medical professional for medical advice.

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