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A primary care physician typically practices general medicine and may be the first person you see for non-emergency medical care. In a Medicare Advantage HMO plan your primary care physician may also be a gatekeeper for you to get care from specialists and other providers. You may need a referral from your primary care doctor to see other doctors.
You can use Medicare’s physician compare tool to find a primary care physician near you. Just type in your city and state and the term “primary care.” You will get results for doctors that are categorized as “family practice,” “general practice” “internal medicine” and “geriatric medicine.” Any one of these doctors may be able to be your primary care physician.
If you have Original Medicare (Part A and Part B), Medicare Part B generally covers medically necessary services and tests you get in a doctor office including visits to your primary care physician. You generally pay 20% of the Medicare approved amount, except for certain preventive services. Because this amount is a coinsurance (a percentage) you won’t know the actual costs until you receive the bill.
If you have Medicare Advantage, you may pay a copayment for a primary care doctor visit. A copayment is a set dollar amount, for example $10, that you pay for an office visit for a primary care doctor. A benefit of Medicare Advantage is knowing in advance what you will typically pay for a doctor visit.
When you are looking for a primary care doctor near year, you might want to consider:
If you have Original Medicare, you can visit any doctor that accepts Medicare assignment. However, if you have a Medicare Advantage plan such as an HMO or PPO, you may be required to see in-network doctors to be covered. You may pay more for doctors that are out of network or not be covered at all. Also, costs that you incur for out of network doctors may not count towards your out of pocket maximum.
If you have a rare or life-threatening condition, you may want a doctor who is familiar with it. For example, a PCP may be board certified in hospice and palliative medicine as well as geriatric medicine and internal medicine. If you think you may need hospice care in the near future, a doctor with training in hospice care might be a good fit for you.
Your first meeting with your Medicare primary care physician may be at your “Welcome to Medicare” preventive visit. During this visit your doctor will take your height and weight and blood pressure measurements and give counseling about certain screenings and shots. During this visit you can ask the doctor about herself and evaluate if she is the one you want responsible for your care. If you don’t feel it’s a good fit, you can typically change doctors.
Do you still have questions about Medicare coverage of your primary care physician? You can call eHealth to speak with a licensed insurance agent. If you’d like to explore the various Medicare coverage options in your area, use the Browse Plans button on this page.
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.