Primary Care Physician Assignments with Covered California

Covered California requires Primary Care Physician matching for all Covered California Plans effective January 1, 2017. This is already a feature of Health Maintenance Organization (HMO) plans, but new for Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) plans. This will only affect those in the individual market, and not small business. Covered California felt members would be more likely to use their healthcare if they had a Primary Care Physician as a contact point to help them navigate the system. 


What is a Primary Care Physician?

A Primary Care Physician (PCP) is a physician who is the central point of contact for you as a patient.  A PCP provides you with a long-term source of comprehensive care that also coordinates a range of health care services. This physician helps you access the proper channels in the maze of health care such as finding the right specialist.

A Primary Care Physician can be an internal medicine doctor, family physician, or pediatrician.  Additionally, a physician’s assistant or nurse practitioner can act as your PCP and are called Primary Care Providers.

What is Primary Care Physician Matching?

It basically means your Covered CA insurance plan will assign you a Primary Care Physician as your central point of contact for your health care needs.

A match will be made by January 1, 2017 for existing or renewing plans. For new plans, PCP matching will be made within 60 days of the effective date of coverage.

No action is required by you, an assignment will be made automatically if you do not have one already. Matching will be based on the physician you have been seeing if possible. If you do not have a PCP, a match will be based on a doctor who is closest to your home. The insurance carrier will notify you of your PCP selection or designation.

Keep in Mind:

  • You are not required to see your PCP
  • You can change your PCP at any time
  • You do not need to contact them
  • Each family member can have their own PCP

How will this affect you?

HMO plan members will have no changes as a PCP is already required and part of their process.

PCP matching will not affect how PPO and EPO plans work:

  • Referrals are still not required to see a specialist
  • PPO members can still go to any provider in or outside of their network
  • EPO members must still stay in their network to have their services covered

Doctor assignments truly provides added value. Research shows having a relationship with your primary care doctor is important to your overall health and well-being.

A PCP is a key source in helping you receive the health care that you need including:

  • Health care advice
  • Routine care, health screenings, and immunizations
  • Preventive care services
  • Treatment for common illnesses and injuries
  • Management of chronic conditions
  • Assistance with finding an appropriate specialist
  • Coordination of care with other providers
  • Explanation of  treatment options

More Information about PCP Matching

Covered California pursues a “Triple Aim” goal of “affordability, access, and improved health” for all its members. For questions about PCP matching, call Covered CA at 1- 800-890-7561. To change your PCP, call your health insurance carrier direct.

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