7 tips for choosing a primary care provider with Medicare
How well does your primary care provider (PCP) know you? Do they see you at least once a year? If you don’t have a PCP, you could be missing out on an important relationship when it comes to your health and well-being – a trusted professional who can act as a “quarterback” for coordinating care, especially as you age.
A PCP is more than just a doctor that you see when you’re sick. Over time, they can learn the nuances of your medical history, your reaction to medications and your health goals. Your PCP guides your care journey, helping to ensure your care is necessary and cost-effective.
Studies show that people with PCPs are more likely to get preventive services, including cancer screenings, and report better overall health outcomes.1 Spotting subtle changes in your health early may lead to earlier treatment, better outcomes and possibly lower costs down the road.
It’s never too late to establish this important relationship to help with your own health care journey, so here are seven tips that can help you choose the right PCP for you.
1. Ask around for provider recommendations
The first step to finding a great provider: Talk to your family and friends about their provider. A recommendation from someone you trust can be a good way to identify a highly skilled, helpful provider. But remember: Every person is different. Just because a provider was perfect for your neighbor or your best friend doesn’t mean they are right for you.
2. Make sure you’re covered by your health plan
Once you’ve identified some possible candidates, check whether they work with your health plan. If you have traditional Medicare, call the provider’s office and ask if they accept Medicare patients. If you have a Medicare Advantage plan, call your insurance provider or check your plan’s website to see if the provider is in your plan’s network.
If your plan has a mobile app, you can also use that to check for availability.Costs and coverage can vary when you see an out‑of‑network provider, so be sure to check network status before scheduling an appointment.
3. Do a quality check on your provider
Chances are you wouldn’t hire someone to make repairs in your home without doing a little research into the quality of their work. So why would you choose a provider without doing the same?
If you have a Medicare Advantage plan, check with your insurance company to see if they have any information about the quality ratings of specific PCPs in your network. You can also use the Care Compare tool on Medicare.gov to access information that may help you compare providers.
Finally, check to see whether your provider is board-certified through the Certification Matters site, which the American Board of Medical Specialties maintains. Board-certified PCPs have not only met the licensing requirements of their states but also completed additional training and ongoing professional development in their medical specialty. Providers also have to keep up with the latest developments in their fields to maintain their certification, to help ensure they’re giving you up-to-date advice.
4. Place a cold call to a provider’s office
Call a potential provider’s office for a first impression of the practice. You can tell a lot by the phone etiquette of the office staff. Ask if they’re taking new patients and see how they answer. If they say, “The next appointment is in 90 days, have a great day,” that’s a lot different than saying, “He’s really busy, and we always make time for existing patients, so it might take us some time to fit a new patient in.”
5. Ask questions
Asking questions during that initial call can provide a sense of how the office runs. Even a routine appointment can be a lot to take in, so getting as much information as possible beforehand can help set you up for a successful visit.
- How does the office handle prescription refills?
- How do they let you know about test results?
- Can you email your provider or schedule appointments online?
- Will the office call to remind you if you’re overdue for an annual screening or a flu shot?
- Will they offer same-day appointments?
- How long do patients typically sit in the waiting room for an appointment?
- Does the provider conduct virtual visits? How easy is it to schedule a virtual appointment?
6. Keep your health needs in mind
Every person has unique health needs, and those needs change as we age. Ask your provider about their specialties or areas of interest that might align with your health needs or goals. As time passes, PCP can become more familiar with your medical history and can help spot changes that might need a referral to a specialist.
If you have multiple complex medical issues, you may benefit from seeing a geriatrician. Geriatricians specialize in the care of older patients.
7. Trust your gut
Your PCP should be a problem-solver and an important, central advocate for your health. It’s critical that you trust them and feel comfortable asking questions.
The American Academy of Family Physicians recommends that after your first appointment, ask yourself the following questions:2
- Do you feel at ease with this provider?
- Did the provider show an interest in getting to know you?
- Did they answer all your questions?
- Did they explain things in a way you understood?
If something seems off, trust your instincts and look for a new provider who is a better fit. You should be comfortable with whomever you choose. Over time, your relationship with a PCP can really pay off for both your health and your budget.
Share
