Medicare Advantage and the Primary Care Physician
A Primary Care Provider is a Health Guide and Advocate
The role of the primary care provider (PCP) is to assess and guide the patients’ integrated health and medical care. A primary doctor or PCP serves as the main gatekeeper to your care plan and makes referrals on your behalf.
Primary doctors and nurse practitioners can offer guidance, including routine checkups, preventive screenings and chronic condition management. They may investigate your medical concerns and make doctor referrals to other specialties like neurology or orthopedics.*
The PCP’s office can help centralize any services you receive from various providers and medical facilities, such as lab tests. In fact, the PCP may help you avoid unnecessary procedures to save on member costs and hassles in the long run.
A primary doctor may sustain long-lasting relationships with their patients and encourage preventive measures to promote a longer, happier life. Patients can check with their PCP when they have new health concerns or questions about lifestyle topics such as chronic pain or how to stop smoking.
Do I need a PCP on Original Medicare?
Original Medicare (Part A and B) does not require you to choose a PCP on a health insurance plan. If you have a Medicare Advantage HMO plan, though, you will select a main provider. A PCP’s office on an HMO can prove to be an organized hub of your medical history and future care plan.
Medicare Advantage PPO plans may or may not require you to choose a PCP.*
Regardless of the Medicare plan option you choose, designating a PCP can ensure timely screenings and preventive tests to keep you healthy and active all year long. Your PCP may help you get the most benefits from your health insurance plan.
Primary care coverage under Medicare
The PCP can help you complete the Welcome to Medicare preventive visit within the first year of having Part B of a Medicare Advantage plan. This isn’t a physical exam. Rather, it’s an opportunity to review your health history, identify the preventive screenings you need and discuss the risk factors for certain conditions.
You’ll also receive Medicare’s annual wellness visits. During these PCP appointments, they’ll review your medications and perform a physical exam. You may need to provide a urine sample or give blood. The PCP may ask leading lifestyle questions, such as the date of your last vision test or COVID-19 vaccination.
If you have a Medicare Advantage plan, check to see if you earn incentives for completing these wellness visits and preventive screenings like mammograms.
A PCP can be a health champion when they know your story
Establishing a collaborative connection with a PCP will help you better manage your health and wellness needs that can change over time. Your main provider offers continuity of care, which may lead to better health outcomes, convenience and satisfaction.
It’s easy to find primary providers that accept Medicare near you. You can contact Medicare, search online and ask family and friends for recommendations.
Enroll in a Prominence Medicare Plan
Call 866-747-8855 to join a Prominence Medicare Advantage plan. Our provider network presently offers members access to quality medical services in Florida, Nevada and Texas.
* All benefits not available on all plans
Enroll in a Prominence Health Plan Medicare Advantage plan.
The comprehensive provider network offers members excellent access to quality medical services.
