To choose a primary care doctor, start with your health plan's network, then pick the type of doctor that fits your household. Next, check location, hours and whether the office takes new patients. Finally, call to confirm the doctor accepts your exact plan. An in-network doctor keeps primary care affordable and makes referrals easier.
- Most plans let you choose any available primary care provider in the network, and you can pick a network pediatrician for your child.
- You don't need a referral from your primary doctor to see an in-network OB-GYN.
- Many preventive services are covered at no cost when you see an in-network provider, even before your deductible.
- HMO and POS plans often require referrals, so your doctor choice matters more on those plans.
- Provider directories can be out of date, so always call the office to confirm your exact plan.
Why a primary care doctor matters
Your primary care doctor is your home base for health care. Some people simply call this their family doctor. This doctor handles checkups, sick visits and screenings. In addition, they keep track of your history and your medicines. When you need a specialist, they help you find the right one.
That matters for cost, too. A routine problem handled by your own doctor usually costs less than a trip to urgent care or the ER. So it pays to pick someone before you get sick, not while you're searching in a hurry.
What your main doctor does for you
- Yearly checkups and screenings your plan covers
- Care for colds, infections and minor injuries
- Ongoing care for conditions such as high blood pressure
- Referrals to specialists when your plan needs one
- One place that keeps your records and medicine list
Because one office sees the whole picture, you repeat your story less often. Also, your doctor can spot patterns that a walk-in clinic would miss.
Start with your plan's network
First, find out which doctors your plan works with. An in-network doctor has agreed to the carrier's rates, so you pay less. Meanwhile, some plans pay nothing outside the network except in an emergency. Our guide to HMO, PPO, EPO and POS networks explains each rule.
- Open your carrier's search tool
Use our doctor search links for every carrier. Then pick your exact plan name, not just the carrier.
- Filter by ZIP code and specialty
Choose family medicine, internal medicine or pediatrics. Also note which hospitals each doctor uses.
- Make a short list
Pick two or three names close to home or work. That way, you have a backup if one office is full.
- Call to confirm
Ask the office if they take your plan and new patients. Directories can lag behind real changes.
For a closer look at that last step, see how to confirm a doctor takes your plan. And if your current doctor drops out, read what to do when a doctor leaves your network.
Every carrier builds its own network
Two plans from the same carrier can even use different networks. For example, compare how the Ambetter network works with how UnitedHealthcare's network works. So always search by the exact plan name on your ID card.
Family medicine, internal medicine and other options
Several kinds of providers can serve as your main doctor for primary care. So the best choice depends on who in your home needs care.
| Provider type | Who they see | Good fit when |
|---|---|---|
| Family medicine | All ages, from babies to grandparents | You want one office for the whole family |
| Internal medicine | Adults only | An adult has several conditions or medicines |
| Pediatrics | Children and teens | Your child needs a doctor focused on kids |
| Nurse practitioner or PA | Often all ages, depending on the practice | Shorter waits matter, or doctors aren't taking new patients |
Nurse practitioners and physician assistants often provide primary care, too. In fact, they can be a good option when doctors in your area have long waitlists.
Your rights when you choose a primary care doctor
The ACA added some patient protections that help here. HealthCare.gov lists three rights that matter most when you choose a doctor.
- You can choose any available primary care provider in your plan's network
- For your child, you can pick any available network pediatrician as their main doctor
- You don't need a referral before you see an in-network OB-GYN
- Plans can't charge higher copays for out-of-network emergency room care
However, these rights generally don't apply to grandfathered plans bought or created before March 23, 2010. If you're not sure, check your plan papers or ask an agent.
A licensed Vivna agent can look up your doctors in each plan's network before you enroll, at no cost to you.
What primary care visits cost
Many preventive services are covered at no cost when you use an in-network provider. That's true even before you meet your deductible. Examples include many shots and screening tests. Our guide to what health plans cover lists more.
Sick visits are different. For example, a visit for a sinus infection or back pain usually has a copay, or it counts toward your deductible. Then, if the doctor finds a problem during a checkup, follow-up care may cost extra. Learn how copays and coinsurance work so the bill makes sense.
Stay in network for labs and imaging, too. Your doctor may be in network while the lab they send you to is not. So ask where your bloodwork goes before you leave the office.
Surprise bills at in-network hospitals
Sometimes your doctor sends you to an in-network hospital, but a provider there is out of network. In that case, the No Surprises Act protects you from many surprise out-of-network bills. CMS says this covers emergency room visits and care tied to a visit at an in-network hospital, outpatient department or surgery center.
Video visits can also save time for simple follow-ups. See our guide to getting care by video or phone for details.
Questions to ask before your first visit
A good fit goes beyond the network. So when you call the office, ask a few practical questions.
- Are you taking new patients on my exact plan?
- How soon can I get a first appointment?
- Do you offer evening, weekend or video visits?
- How do referrals and prescription refills work?
- Which hospital do your doctors use?
- An office that can't confirm your plan name
- Months-long waits for a basic visit
- No clear way to reach the office after hours
How to switch doctors within your network
You can usually change doctors within your network at any time. People switch after a move, a plan change or a visit that felt rushed.
- Search your network again
Use the same steps as above. Then call to confirm the new office takes your plan.
- Update your carrier
HMO plans may ask you to name your main doctor. So change it in the portal or by phone.
- Move your records
Sign a release so your old office sends your records. Also bring a list of your medicines.
- Book a first visit
Next, schedule a checkup soon. That way, your new doctor knows you before you're sick.
Choosing a plan with strong primary care
Your plan type shapes how you use primary care and which doctor you see. For example, HMO and POS plans often need a referral before you see a specialist. On the other hand, a PPO lets you see providers outside the network for an extra cost. Read how HMO and PPO plans differ before you decide.
An HMO can cost less if that doctor is in its network.
A PPO or POS plan may make referrals and access easier.
Look for a family medicine office in network for everyone.
Give us the names of your doctors before you compare plans. We check each one in the network of every plan you're considering. Then we show you the cheapest plan that keeps them, so you don't lose your doctor to save a few dollars.
Pick the doctor first, then the plan that keeps them.The order our licensed agents follow on every call
Open Enrollment each fall is the main time to switch plans, so see our Open Enrollment dates and checklist. Then compare ACA and private plans in your ZIP code, or call 888-730-6001.
Primary care doctor: FAQs
How do I find an in-network primary care doctor?
Start with your carrier's online directory and choose your exact plan name. Then filter by ZIP code and specialty, such as family or internal medicine. Because directories can be out of date, call the office to confirm it takes your plan and new patients. A Vivna agent can also run the search with you.
Should my family doctor practice family or internal medicine?
Family medicine doctors see patients of all ages, so one office can care for your whole household. Internal medicine doctors see only adults. That focus can suit adults with several ongoing conditions or medicines. Either one can serve as your main doctor, as long as they're in your plan's network.
Is a yearly checkup free with insurance?
Often, yes. Many preventive services are covered at no cost when you see an in-network provider, even before you meet your deductible. However, if you bring up a new problem during the visit, that part may cost a copay or count toward your deductible. So ask the office how they'll bill it.
Can a nurse practitioner be my PCP?
In many plans, yes. Nurse practitioners and physician assistants often provide primary care, and many plans let you choose one. This can also help when doctors near you aren't taking new patients. Check your plan's directory, then confirm with the office that they accept your plan.
What if no PCP near me takes new patients?
First, ask each office about a waitlist or a nurse practitioner on staff. Next, widen your search a few miles. Video visits can also bridge the gap for simple needs. If the network still looks too thin, consider a plan with a wider network at Open Enrollment.
Vivna's licensed agents compare plans from 50+ carriers. Call Monday through Friday, 9am to 6pm.
Sources
- HealthCare.gov: Doctor choice and emergency room access
- CMS: Your rights and protections against surprise medical bills
- HealthCare.gov: Preventive health services
- HealthCare.gov: Health insurance plan and network types
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Plan availability, networks and benefits vary by state and change over time.