primary care provider (PCP)

What is a primary care provider?

A health care professional who is responsible for monitoring and coordinating an individual’s overall health care needs. Typically, a PCP serves as a “quarterback” for an individual’s medical care, referring the individual to specialists as needed.

What type of provider can be a primary care provider?

A primary care provider can be a medical doctor (MD), a doctor of osteopathic medicine (DO), a nurse practitioner, a clinical nurse specialist or a physician’s assistant.¹

Several types of MDs can serve as a person’s primary care provider:²

• Internal medicine doctors
• Pediatricians (if the patient is a child)
• Family medicine doctors (for patients of any age)
• OB/GYNs (obstetrics and gynecology)
• Internal medicine-pediatric doctors

Although OB/GYNs specialize in care related to the female reproductive system, the Affordable Care Act ensures that women have the option to choose an OB/GNY as their primary care provider, and cannot be required to obtain a referral from another PCP to see an OB/GNY.³

Why do I need a primary care provider?

If your health plan is an HMO or a POS plan, it will likely require you to have a primary care physician, and will assign one for you if you don’t select your own (you always have the option to pick a different PCP). These plans generally require members to have a referral from their PCP to see a specialist.

If you have a PPO or an EPO, your plan will likely not require you to select a PCP, but you might want to have one anyway. This person will help to coordinate the care you receive from specialists and generally keep tabs on your overall health.