What is a Primary Care Physician?

Many health plans require you to choose a doctor to see for routine care. This doctor is called your Primary Care Physician (PCP).

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In addition to routine care, you’ll see your Primary Care Physician any time you have a health question or potential illness. This doctor will give you an initial diagnosis and a referral to see a specialist within the health plan’s provider network. Without this referral, your plan may not cover the cost of seeing the specialist.

Primary Care Physicians are usually:

  • General Practitioners (specializing in “family medicine”)
  • Internists (specializing in care for adults)
  • Pediatricians (specializing in care for children)
  • OB/GYNs (specializing in care for women)

If you have certain health conditions, your plan may allow you to choose a doctor who specializes in treating that condition as your Primary Care Physician.

Usually, HMO plans and POS plans will require you to choose a Primary Care Physician. PPO plans and FFS plans will not.

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