PCP Management

Yes. Having a PCP helps ensure you get preventive and routine services and that your overall care is coordinated with any specialty services you may need.

Note: Generations Advantage HMO and HMO-POS plan members are required to have an in-network PCP on file. PPO-style plans do not require an in-network PCP.

No. Members can choose any provider within our network, which includes providers at our Martin’s Point Health Care Centers and other participating health care providers in the areas where our health plans are offered.

Using in-network providers ensures the best coverage and lowest out-of-pocket costs.

You can use your health plan's Provider Directory on the Martin’s Point website to search for a provider by name, specialty, or location.

Access your Provider Directory by using the links below, or by clicking the "Find a Provider" option under the TRICARE Plans or Medicare Plans dropdown menu.

When using the Provider Directory, you will see a profile of each in-network provider in your search results. An icon that says “Accepting new patients” will appear if a provider is accepting new patients to their practice (see image below).

We recommend calling the provider’s office to confirm that they are accepting new patients.

Yes. Member Services can assist in finding providers who are accepting new patients and help update the PCP on file.

Once you have established care with your PCP, you should notify the plan. To do so, you can either:

• Log in to your Member Portal and add or change your PCP information.

• Contact Member Services

Yes. You can change your PCP anytime, for any reason. Once you’ve established care with your new PCP, you should notify the plan via the Member Portal or by calling Member Services.

Updated PCP information provided by phone typically takes one or two business days to reflect in our system.

If your designated PCP leaves the network, we’ll notify you by mail and provide you with the guidance needed to choose a new PCP.

In some cases, when members enroll and haven’t yet selected a PCP, we assign one to ensure they have access to care right away.

Members can change their PCP anytime and notify the health plan through the Member Portal or by calling Member Services once care has been established.

Yes. Nurse Practitioners (NPs), Family Nurse Practitioners (FNPs), and Physician Associates (PAs) are licensed providers who can serve as a PCP. They work closely with physicians and the care team to provide care.

Sometimes a doctor’s name appears as your PCP even though you regularly see a Nurse Practitioner (NP) or Physician Associate (PA) in their office.

That’s because your NP or PA works closely with the doctor as part of your care team. In some cases, the doctor’s name is listed for administrative or billing purposes, but you’ll continue to see your regular provider for your appointments and ongoing care.