Under the rationale that “more is better,” you might be wondering if you can have more than one primary care doctor and if Medicare will pay for it.
The short answer is that it depends, and this article will outline how having multiple primary care physicians works when you have different types of Medicare. You’ll learn how the rules differ, depending on whether you have Original Medicare, Medigap, or a Medicare Advantage plan.
What is a Primary Care Doctor?
As part of our ongoing coverage of Medicare explained, it can be helpful to define what a primary care doctor is and how this person fits into your overall medical care.
Your primary care doctor or primary care physician (PCP for short) is the physician a person sees for routine and ongoing health care services. In addition to helping patients with preventative care, screening for diseases, prescribing medicine, and treating illnesses, primary care doctors are also the person who will refer you to a specialist if you need more specific medical treatment.
Why You Might Want to Have Two Primary Care Physicians
Most people trust doctors, and more than 9 in 10 people put faith in physicians. However, doctors are human, and they’re not 100% infallible. According to a recent BMJ publication, 12 million patients annually face adverse effects from doctors that misdiagnose medical conditions or treat them incorrectly. In the hospital setting, these statistics are even more dire.
Further, doctors have different training and methods, meaning that a diagnosis can differ from one doctor to the next. So, even if you trust your doctor implicitly with your health, it can be wise to work with multiple health care providers to ensure that no stone goes unturned when it comes to your health.
Another reason you might want two PCPs is if you travel extensively for work, resulting in you spending time in multiple states, cities, or countries. It’s also possible to have residency in multiple states.
If you ultimately spend time in more than one location, you might benefit by having insurance coverage that allows you to have multiple doctors without paying extra premiums or healthcare costs.
To sum up, the benefits of patients having two physicians include:
- The ability to seek second opinions
- Having multiple doctors familiar with your health and medical programs
- Seeing a trusted physician for medications and treatments across multiple states or geographic regions
- Correcting a mistake made by one of your doctors
Getting a Second Opinion from a Doctor with Medicare
In some instances, Medicare can pay for a second opinion. Typically, coverage extends only in cases where the patient is facing surgery or a significant medical procedure.
Even when Medicare does cover the cost of another doctor visit, patients still have to pay coinsurance or a deductible for services received under Medicare Part B. To further clarify, these second opinions are for a consult or treatment from doctors in the same field, not specialists. Being referred to a specialist is not always required, depending on your Medicare plan.
Disadvantages of Having Two PCPS
More isn’t always better, especially when it comes to having multiple doctors and having to pay more for insurance. For example, if you have Medicare Advantage, you might not have coverage that provides for seeing two doctors for the same service. As a result, you could have to pay additional costs for treatment.
While it can be beneficial to have the option to consult with multiple primary care doctors to manage your health, it’s worth noting the potential disadvantages of having another health care provider (other than the additional cost related to coverage):
- Duplication of efforts: Seeing two doctors can equate to having to spend more time in hospitals and going back and forth between appointments.
- Disagreements: Because doctors have unique perspectives, you could get conflicting opinions, making it difficult to know how to proceed with patient care.
- Hard to make decisions: Disagreements between doctors and second-guessing what a provider says can make health care decisions even more difficult.
Having Two Primary Care Physicians with Original Medicare
Original Medicare, which includes Medicare Part A and Medicare Part B, allows you to have two primary care physicians. As a reminder, Medicare Part B works like traditional insurance and covers outpatient services. Though you are allowed to have two PCPs, you cannot schedule appointments for a doctor visit between two offices on the same day. Further, Original Medicare will enable you to see specialists without getting a referral from your primary care physician.
Having Two Primary Care Physicians with Medigap
A Medigap plans that you have Original Medicare and you’ve added Medicare Supplement insurance to cover the costs of your medical care. With a Medigap plan, you have coverage to see multiple doctors, and Medicare will pay for it.
The only limit to this coverage is that you have to see a doctor that accepts Medicare if you are seeing multiple doctors under a Medicare Supplement insurance plan.
Having Two Primary Care Physicians with Medicare Advantage
Because Medicare Advantage is purchased from private health insurance companies, whether you can have more than one primary care physician depends on your specific health insurance plan. As a reminder, Medicare Advantage provides you with the benefits of Original Medicare along with other services generally not covered by Original Medicare, such as dental and vision benefits.
Generally, the rules for coverage of having more than one primary care physician are as follows:
- HMO (Health Maintenance Organization) – You can only have one primary care physician, and your physician will serve to coordinate care with specialists
- PPO (Preferred Provider Organization) – You are generally allowed to see two primary care doctors
- PFFS (Private Fee-for-Service) – You can have two primary care physicians
- SNP (Special Needs Plan) – A SNP limits you to one primary care physician
The above information about Medicare is a general rule; your Medicare insurance plan could be different.
If you’re in the process of choosing Medicare Advantage plans or deciding whether Original Medicare with a Medigap policy is best for your health needs, contact a Medicare advisor to help with your medical planning.