How do I change my primary care doctor on Medicare?

Let’s start with the basics. It’s not always a doctor!

A primary care provider (PCP) is the main doctor or medical professional you see first when you need care. This could be a doctor, nurse practitioner, or physician assistant. They help keep you healthy with regular checkups and shots. And when you’re sick or injured, they can diagnose and treat a wide range of conditions from the flu to a sprained ankle.

If you need specialized care, your PCP can provide a referral. Do you have allergies? Do you need a knee replacement or an MRI? Your PCP can help you find the care you need.

Best of all, a good PCP will get to know you over time, so they can be a true partner in helping you achieve your best health.

Well, like many things when it comes to Medicare—it depends. Let’s take a closer look.

Original Medicare

If you’ve signed up for Original Medicare, no. You simply have to use doctors who accept Medicare. Most do. In fact, 98% of non-pediatric doctors accept Medicare patients.¹

Medicare Advantage

If you opt for a Medicare Advantage plan, the rules may be a little different, depending on the type of plan you choose.

Some Medicare Advantage plans are health maintenance organization (HMO) plans. With an HMO, you must choose a primary care physician (PCP) from a network of local healthcare providers when you join. Your PCP will provide referrals to a specialist or other care providers when needed. You can change your PCP as often as you like.

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket.

Some Medicare Advantage members choose a preferred provider organization (PPO) plan. With a PPO, you have the flexibility to visit providers outside of your plan’s network. But visiting an out-of-network healthcare provider will generally cost you more.

PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

How to change your primary care doctor

If you have Original Medicare and you want to switch to a new doctor, visit Medicare’s doctor finder to find options in your area.

If you have Medicare Advantage, start with your plan provider’s website. Most private insurance companies who offer Medicare Advantage plans will have a “find doctors in your network” option on their pages. Most will also allow you to search by location, by gender or by other factors that may help you decide. Once you find a potential PCP, call their office to ask if they’re accepting new patients and to confirm that they are in your plan’s network.

Before you leave your current doctor, ask for a copy  of your medical records to take with you. Your doctor is required by law to provide those records to you. The records will make it easier to get started with your new primary care provider.

Your PCP is your partner in health

Some people only see their doctor when they’re sick or injured. Others may have a chronic condition that requires constant monitoring. Either way, your PCP should be someone you trust and are comfortable with. Take the time to find your true partner in health.