What Is the Difference Between a Specialist and a General Practitioner?

A general practitioner provides broad medical care, focusing on preventive services, routine check-ups, and general health concerns. A specialist is a doctor with advanced training in a specific area of medicine, such as cardiology, orthopedics, or oncology.

When do you need a specialist?

• Complex or chronic conditions: Specialists provide targeted expertise for conditions like heart disease, diabetes, or cancer.
• Advanced testing and procedures: They perform diagnostic tests and treatments beyond the scope of a primary care doctor.
• Referrals and coordination: Many insurance plans, including Medicare Advantage, require a referral from a primary care physician before seeing a specialist.

Specialists and Medicare coverage

• Original Medicare: Covers specialist visits under Medicare Part B, though beneficiaries are responsible for deductibles and coinsurance.
• Medicare Advantage (Part C): Often requires referrals and may limit access to in-network specialists.
• Supplemental coverage: Medigap plans can help cover specialist visit costs not paid by Original Medicare.

How Solace can help

A Solace advocate can help determine when a specialist visit is necessary, explain Medicare coverage for specialist care, and assist in obtaining referrals, finding in-network specialists, and securing prior authorizations. They can also schedule timely appointments and make sure all your providers consistently communicate with one another.

What to do next

Need help coordinating specialist care or understanding your insurance coverage? Find an advocate today.