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.