How do I switch primary care doctors?
How do I switch primary care doctors?
Under a plan with a network, HealthCare.gov lists choosing any available in-network primary care provider as a right, though not under plans created or bought before March 23, 2010. Once you find a doctor who meets your needs, familydoctor.org suggests scheduling an appointment so you can meet and talk with the doctor. Records are a separate step. Ciox Health v. Azar, a 2020 federal court case, narrowed one part of HIPAA. HHS's notice says the right to have a copy sent to a third party you name now applies to a copy of an electronic health record in electronic format. The same notice says your right to access your own records is unchanged.
This is not clinical evidence and not medical advice. It does not replace your care team. Discuss anything here with your clinician before you act on it.
Arun Verma, co-founder of Triangle · Published
Switching primary care doctors involves your insurance plan, the new office and your records from the old one. This page sticks to what federal and AAFP sources say about each.
How do I check that a new doctor takes my plan?
For a Marketplace plan, HealthCare.gov's steps include checking the plan's provider directory, calling the insurer (the number is on your insurance card) and calling the doctor's office, which can tell you whether it accepts your plan. It also notes that seeing an in-network provider usually means lower out-of-pocket costs, even though you may be able to see others. Medicare.gov says a Medicare Advantage plan can add or remove providers at any time. Its fact sheet on provider networks says to confirm with the provider, when you schedule, that they are still in your plan's network.
Will I need referrals, and does my plan type matter?
Under Medicare, plan type matters. Medicare.gov's side-by-side says Original Medicare lets you use any doctor or hospital that takes Medicare, anywhere in the U.S., and in most cases needs no referral to see a specialist. A Medicare Advantage plan may limit you to network providers and may require a referral. Within Medicare Advantage, Medicare.gov says many HMOs require a referral from your primary care doctor for specialist care, and its plan-type table lists no referral for PPOs. Medicare.gov says that in some Medicare Advantage plans, choosing a primary care doctor also chooses the hospitals and specialty networks tied to that doctor. For an employer or Marketplace plan, a fair question for the insurer is how its own referral rules work.
What if my doctor leaves my plan's network?
In a Medicare Advantage plan, a doctor can leave the network at any time. Medicare.gov says you would then need to choose a new in-network provider to get covered services, though some plans offer non-emergency coverage out of network, typically at a higher cost. Medicare.gov says the plan should make a good faith effort to give you at least 30 days' notice, and that it will notify you if a provider you go to regularly, like your primary care provider, is leaving. It also says a plan that changes its network must still protect you from interruptions in medical care.
What does the new office need from my old one?
Your records: ONC says a full record is best when switching to a new primary care provider. Separately, HHS says a provider may send your records to another provider only as needed for treatment or payment or with your permission. The Privacy Rule does not require a provider to share information with other providers or plans. HHS also says the Privacy Rule gives you, with few exceptions, the right to inspect, review and receive a copy of your medical and billing records held by covered health plans and providers. The Ciox order narrowed the right to have a copy sent to a third party you name. ONC's guide, How to Get It, explains how to ask for a record.
What can I ask a new office before booking?
Whether the office is taking new patients and whether it accepts your insurance are the first two questions on familydoctor.org's list for a doctor's office. The list goes on to office hours, after-hour walk-in hours, on-call hours, the average wait time for an appointment, what hospital the doctor uses and how many doctors are in the practice. It also asks whether labs and imaging tests are done in the office and, if not, whether patients are referred to a place that is in their insurance network, and who will care for you if you are admitted to the hospital or an extended care facility. You could put any of these to an office on a first call.
What should I bring to the first visit?
AHRQ's tips for before an appointment start with bringing all the medicines you take, including non-prescription ones such as aspirin or antacids, and include writing down your questions and knowing your current medical conditions, past surgeries and illnesses. ONC describes a partial record, such as allergies, medications, immunizations, a single visit's notes or test results, as useful for sharing specific health information. It also says that if you are unsure what to ask for, you can ask the provider's office for guidance.
How do I know the new doctor is a good fit?
familydoctor.org suggests that, before deciding on a doctor, you ask yourself questions such as whether the office was easy to get to, whether staff were friendly and check-in was smooth, whether you were comfortable with the doctor, and whether the doctor answered all your questions and explained things so you understood. It also says it takes time to build a relationship with your doctor.
Sources
- HealthCare.gov: Doctor Choice & Emergency Room Access: HealthCare.gov says you have the right to choose any available primary care provider in your insurance plan's network.
- HealthCare.gov: Doctor Choice & Emergency Room Access: HealthCare.gov says these rights don't apply to health plans created or bought before March 23, 2010, known as grandfathered plans.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org says that once you find a doctor who meets your needs, you schedule an appointment, which allows you to meet and talk to the doctor.
- HHS OCR: Important Notice Regarding Individuals' Right of Access to Health Records (Ciox order): HHS's notice says that on January 23, 2020 a federal court (Ciox Health, LLC v. Azar) vacated the HIPAA third-party directive insofar as it expands beyond requests for a copy of an electronic health record with respect to protected health information in an electronic format.
- HHS OCR: Important Notice Regarding Individuals' Right of Access to Health Records (Ciox order): HHS's notice says the right of individuals to access their own records is undisturbed and remains in effect.
- HealthCare.gov: Getting regular medical care: HealthCare.gov's steps for finding a doctor in your plan include checking the plan's provider directory, calling your insurer (the number is on your insurance card and the insurer's website) and calling your doctor's office, which can tell you if they accept your health plan.
- HealthCare.gov: Getting regular medical care: HealthCare.gov says most health plans give the best deal when you see a doctor with a contract with your plan, that you may be able to see doctors who don't contract with your plan, and that an in-network provider usually means lower out-of-pocket costs.
- Medicare.gov: Understanding Your Medicare Advantage Plan's Provider Network (CMS Product No. 11941, May 2026) (p. 1): Medicare.gov's fact sheet on Medicare Advantage provider networks says a plan can add or remove providers from its network at any time during the year.
- Medicare.gov: Understanding Your Medicare Advantage Plan's Provider Network (CMS Product No. 11941, May 2026) (p. 1): Medicare.gov's fact sheet says to check with your provider when you schedule an appointment to confirm they are still in your plan's network.
- Medicare.gov: Understanding Medicare Advantage Plans (CMS Product No. 12026) (At a glance, p. 3): Medicare.gov's at-a-glance comparison says Original Medicare lets you use any doctor or hospital that takes Medicare anywhere in the U.S. and in most cases needs no referral to see a specialist, while a Medicare Advantage plan may require network providers in its service area and may require a referral for a specialist.
- Medicare.gov: Understanding Medicare Advantage Plans (CMS Product No. 12026) (HMO description, p. 15): Medicare.gov says many HMOs require you to get a referral from your primary care doctor for specialist care.
- Medicare.gov: Understanding Medicare Advantage Plans (CMS Product No. 12026) (Section 3 table, p. 22): Medicare.gov's table of Medicare Advantage plan types lists referrals as required for HMOs and not required for PPOs.
- Medicare.gov: Understanding Your Medicare Advantage Plan's Provider Network (CMS Product No. 11941, May 2026) (p. 1): Medicare.gov says that in some Medicare Advantage Plans, when you choose a primary care doctor you are also choosing the hospitals and specialty networks associated with that doctor.
- Medicare.gov: Understanding Your Medicare Advantage Plan's Provider Network (CMS Product No. 11941, May 2026) (p. 1): Medicare.gov says a provider can leave a Medicare Advantage plan's network at any time, and if the provider is no longer in-network you need to choose a new provider in the plan's network to get covered services; the same fact sheet says some plans offer non-emergency coverage out of network, but typically at a higher cost.
- Medicare.gov: Understanding Your Medicare Advantage Plan's Provider Network (CMS Product No. 11941, May 2026) (p. 1): Medicare.gov says the plan should make a good faith effort to give at least 30 days' notice that a provider is leaving the network, and will notify you if a provider you go to regularly, like your primary care provider, is leaving.
- Medicare.gov: Understanding Your Medicare Advantage Plan's Provider Network (CMS Product No. 11941, May 2026) (p. 1): Medicare.gov says that even though a Medicare Advantage plan can change networks at any time, it must protect you from interruptions in medical care.
- ONC (HealthIT.gov): How to Get It (Get it. Check it. Use it.): ONC says a full record is best when switching to a new primary care provider or for your personal use.
- HHS: Your Medical Records: HHS says a health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.
- HHS: Your Medical Records: HHS says the Privacy Rule does not require the health care provider or health plan to share information with other providers or plans.
- ONC (HealthIT.gov): How to Get It (Get it. Check it. Use it.): ONC says its guide offers tips on how to request your health record and has a section titled How Do I Ask for My Health Record?
- HHS: Your Medical Records: HHS says the Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org's questions for a doctor's office include whether they are taking new patients and whether they accept your insurance.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org's questions also include office hours, after-hour walk-in hours, on-call hours, the average wait time to get an appointment, what hospital the doctor uses and how many doctors are in the practice.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org asks whether labs and imaging tests are done in the office and, if not, whether patients are referred to a place that is in their insurance network.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org asks who will care for you if you are admitted to the hospital or an extended care facility.
- AHRQ: Be More Engaged in Your Healthcare: Tips for Patients (AHRQ Pub. No. 21-0007) (Before Your Appointment): AHRQ's tips for before an appointment say to bring all the medicines you take, including prescription medicines and non-prescription medicines such as aspirin or antacids.
- AHRQ: Be More Engaged in Your Healthcare: Tips for Patients (AHRQ Pub. No. 21-0007) (Before Your Appointment): AHRQ's tips for before an appointment say to write down the questions you have for the visit and to know your current medical conditions, past surgeries and illnesses.
- ONC (HealthIT.gov): How to Get It (Get it. Check it. Use it.): ONC says a partial record is useful if you want to share specific health information with new providers or others, such as allergies, medications, immunizations, a provider's notes from a single visit, or test results or X-rays.
- ONC (HealthIT.gov): How to Get It (Get it. Check it. Use it.): ONC says that if you are unsure what to ask for, you can ask your provider's office for guidance.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org suggests that, before deciding on a doctor, you ask yourself questions such as whether the office was easy to get to, whether staff were friendly and check-in smooth, whether you were comfortable with the doctor, whether the doctor answered all your questions and whether the doctor explained things so that you understood.
- AAFP familydoctor.org: How to Choose a Family Doctor (last updated October 21, 2025): familydoctor.org says it takes time to build a relationship with your doctor.
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