What You Need to Know When Transitioning to a New Primary Care Physician

By RetireMEDiQ

You may find yourself transitioning to a new Primary Care Physician (PCP) due to your current doctor retiring or for a range of other reasons. If you are enrolled in a Medicare Advantage Plan, it’s important that you promptly share this change with your health insurance carrier to prevent undue issues with claims or visits to the new doctor.

When you begin seeing a new PCP, the doctor’s office does not provide your new physician’s information to your health insurance carrier. You are responsible for notifying your carrier of the change, which can affect claims processing, network coverage status and insurance card details. When you contact your carrier, they will be able to provide details relevant to the change, such as confirming if the doctor is considered in-network. Please note that your carrier only needs to be notified of a PCP change if you are on a Medicare Advantage Plan, not a Medicare Supplement Plan.

Once the carrier has the updated Primary Care Physician’s information in their system, they will issue a new insurance card to you that reflects the change in PCP. Since insurance cards include your co-pay amount and PCP’s name, having an accurate card to present at your doctor’s office is imperative. This simple change will help you avoid potentially paying a higher co-pay for an office visit, learning for the first time that your new PCP is considered out-of-network or encountering other problematic situations that could occur if your carrier is not given the updated PCP’s details.

Notifying your carrier of your change in PCPs is also essential to ensuring insurance claims are processed with accuracy. Keep in mind that when scheduling an appointment with your doctor, it is important to share the specific name of your Medicare Advantage plan and confirm if the doctor’s office accepts it.

We want to ensure you experience a seamless transition when you change Primary Care Physicians! If you have questions about switching PCPs or aren’t comfortable calling the carrier directly, we recommend you call a RetireMEDiQ Client Advisor at 1-877-222-1942. We will call your health insurance carrier together with you and guide the conversation as you provide your new PCP’s information and discuss any elements of your plan affected by the change. The call to the carrier is often short and straightforward. After the call, we will update your new PCP’s information in our system. If you do opt to call your insurance carrier directly, please also call RetireMEDiQ to share your new PCP’s details so we can ensure your records are accurate in our system. Having up-to-date information ensures we can provide the best support possible when we assist you with any future billing issues or plan-related questions.

If you are not a RetireMEDiQ client yet and have questions about Medicare or the process of switching Primary Care Physicians, please contact us at 1-866-600-5638 or advice@retiremediq.com!

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Alice Carroll
2 months ago

Thanks for the tip that I should inform my health insurance provider when switching primary care professionals. I will be moving back to my hometown later this year in order to be able to live closer to my parents. Since I would be staying for years, having a new primary care doctor would be ideal.

Jackie Davis
Jackie Davis
2 months ago
Reply to  Alice Carroll

Hi, Alice! We’re glad you found this information useful!