Taking-Advantage-of-Essential-Benefits

When you sign up for a Marketplace plan, one of the first steps you take is choosing your primary care provider (PCP). This practitioner is your ally, your first stop for all your nonemergency healthcare needs and usually your gateway to specialty care. Here are a few helpful questions you can ask yourself as you select PCPs for yourself and your family.

What Does My PCP Do?

Your PCP will diagnose and treat any common healthcare problems you may have and refer you to specialists as needed. He or she will coordinate your healthcare, maintain your medical records, conduct routine diagnostic screenings and help you develop a healthy lifestyle.

Are PCPs Always MDs?

No. The Affordable Health Care Act recognizes the unique benefits offered by a range of professional providers. Depending on your state regulations and the policies of your health plan, you may also be able to choose a nurse practitioner (NP), physician’s assistant (PA), doctor of osteopathy (DO) or naturopathic doctor (ND) as your primary care provider. When your PCP is a physician, you can choose between a family practice doctor, an internist (general adult health), a pediatrician, a geriatrician (elder health) or an obstetrician-gynecologist. Each person in your family can have his or her own PCP.

What Else Should I Pay Attention To?

It’s often possible to schedule a short free or low-cost interview with a potential PCP. You can see if the person is a good fit with your philosophy about wellness and medical interventions, and if he or she communicates in a way that you find comfortable. The Wall Street Journal suggests you seek a PCP who is “competent, caring and connected.”

Does My PCP Have to Be on a Provider List?

Yes. While every Marketplace plan is different, they all have provider networks. Your PCP will be the anchor and center point for your medical care, and you will need to pick someone who is in your health plan’s network.

How Do I Find an In-Network PCP?

Your health plan has a list of its providers, along with their specialties, addresses and a notation of whether they are currently accepting new patients. If you’ve signed up for health insurance via HealthSherpa, you can find these tools in your Consumer Dashboard.  If you have not signed up via HealthSherpa, the easiest way to locate this list is to go to your health plan’s website and look for a link to its provider network. You can also phone your health plan and simply ask for the names and contact information of some of the practitioners located near you.  Once you find an in-network PCP, we recommend that you call the practitioner’s offer to confirm as online details may lag.

Our licensed brokers would be happy to help you understand your in-network options. Call anytime and make an appointment if you have questions.

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