Medicare supplement plans, also called Medigap plans, don’t require you to have a primary care physician (PCP) because these plans do not directly cover healthcare costs.
Instead, they help cover out-of-pocket costs after Original Medicare (parts A and B) coverage kicks in.
If you enroll in a Medigap plan, it means you’re also enrolled in Original Medicare. Part A covers hospital insurance, while Part B covers medical insurance.
Typically, Original Medicare permits seeing any U.S. doctor or hospital that accepts it. You don’t need a PCP, and you won’t need a referral to see a specialist.
You can find primary care doctors who accept Original Medicare in your area on Medicare.gov.
Medicare Advantage (Part C) plans offer the same benefits as Part A and Part B and frequently include prescription drug coverage (Part D).
Plus, these plans might cover services like hearing, vision, and dental care that Original Medicare doesn’t.
That said, if you’re enrolled in a Part C plan, whether or not you’ll need a PCP depends on the type of plan you choose.
There are five types of Part C plans:
Usually, HMO plans require a PCP for referrals, except during emergencies, whereas PPO plans usually don’t. Many SNP plans might also work as HMOs.
Deciding if a Medigap plan is right for you depends on your individual health and financial situation. For one, you can’t use Medigap plans to cover expenses from Part C plans.
But if you’re enrolled in Original Medicare, these plans may be helpful. Original Medicare comes with costs like deductibles, copayments, and coinsurance. It also doesn’t have a cap on out-of-pocket expenses, which could lead to high costs in a year if you need extensive medical treatment.
For this reason, having a Medigap plan could save you money by covering some of these expenses. On the flip side, choosing a Medigap plan means you’ll have to pay higher monthly premiums.