In this instance, as long as the healthcare provider you choose to see accepts Medicare insurance, it is likely that you’re all set. However, this isn’t always the case if you elect to purchase a Medicare Advantage plan, commonly referred to as Medicare Part C, instead of Original Medicare.
If your Medicare Advantage plan is a Health Maintenance Organization (HMO) or Special Needs Plan (SNP), it’s likely that you will be required to select a primary care physician, according to Medicare.gov.
But what is a primary care physician and what does this person do?
What A Primary Care Physician Is And Does
A primary care physician is a healthcare practitioner who is tasked with overseeing all of your healthcare-related needs. Ideally, this person is someone you either have seen before or plan to see over an extended period of time.
The reason is because this gives them the opportunity to get to know you, your health, your family history, and any other information that can potentially help them provide you with the highest level of care possible.
Ultimately, this includes being there to:
- Offer you health and wellness advice
- Suggest and schedule preventive testing that is recommended for you based on your age, family history, and current health condition(s)
- Order diagnostic tests for any medical concerns or issues you may be having
- Act as lead practitioner for any treatment plans required based on your specific healthcare needs
Additionally, in the event that care is required outside of his or her scope of expertise, your primary care physician is also the person responsible for referring you to a specialist or other healthcare provider who can provide the services you need. Typically, this specialist or healthcare provider is also within your particular Medicare Advantage plan’s network.
Types Of Primary Care Physicians
When choosing a primary care physician to lead your health and wellness, many different options exist. Among them are:
Typically, this specialist or healthcare provider is also within your particular Medicare Advantage plan’s network.
Family Practitioner
Healthcare professionals receive the title of family practitioner if they’ve completed a family practice residency, are board-certified (or board-eligible), and are able to treat a broad patient scope (children to adults).
Internist
Internists also work with patients of all ages and are primary care physicians who have completed an internal medicine residency and are either board-certified or board-eligible in this specialty.
Pediatrician
Doctors who specialize in working with children from when they’re newborns to adolescents are called pediatricians. They’re required to complete a pediatric residency and must be either board-eligible or board-certified.
Geriatrician
To be qualified as a geriatrician—a doctor with the skills necessary to effectively tend to the healthcare needs of older adults—the primary care physician must have completed his or her residency in family or internal medicine and be board-certified.
Obstetrician Or Gynecologist
Some women prefer to have an obstetrician or gynecologist as a primary care physician because this healthcare professional specializes in women’s issues. To qualify as a primary care physician in this area, a doctor is required to complete a residency in this specialty and be either board-certified or board-qualified.
Nurse Practitioner Or Physician Assistant
In addition to providing doctors as primary care physicians, some healthcare practices also offer nurse practitioners and/or physician assistants ( commonly referred to as NPs and PAs, respectively) that you can choose from as well. Healthcare practitioners in these roles are not doctors per se, but they have still undergone a high level of training in areas related to health and wellness.
How To Find A Primary Care Physician Near You
Regardless of which type you choose, most Medicare Advantage insurance plan providers offer online searches on their own individual websites, enabling you to see which primary care providers are available based on the specific plans they offer.
Once you identify all of your Medicare Advantage options, your next step is narrow them down to the point where you are able to choose a primary care physician as your lead healthcare provider.
A few of the most well-known include:
If one of these options interests you, you can go directly to the Medicare plan section of their websites to learn more about what options exist in your area.
U.S. News & World Report also offers a list of the best Medicare Advantage insurance companies for 2019 that you may want to look over as well. It is broken down by state so you can quickly identify the company or companies that have earned top honors.
Once you identify all of your Medicare Advantage options, your next step is narrow them down to the point where you are able to choose a primary care physician as your lead healthcare provider.
What To Look For In A Primary Care Physician
If you already have a medical professional you see for all of your healthcare needs, you may want to ask which Medicare plans he or she accepts. This would enable you to keep your current healthcare team simply by choosing a specific Medicare plan.
If you don’t have a doctor you see consistently and are trying to decide who to elect as your primary care physician, the U.S. National Library of Medicine (USNLM) explains that it helps to consider a variety of factors.
This includes looking at:
- How the doctor and his or her office staff treats patients (their friendliness, helpfulness, etc.)
- How easy it is to get in touch with the provider to ask questions or schedule an appointment
- Whether you can get in to see your primary care physician at a time that is convenient to you
- If the provider is as focused on wellness and disease prevention as you’d like
- Whether you prefer a provider who is conservative or aggressive when it comes to treatment
- How difficult or easy it is to get a referral if necessary
- If the provider considers you a partner when deciding the healthcare process best suited to your particular situation and needs
The goal here is to make sure that a particular doctor is a good fit for you.
To help with this, the USNLM suggests talking to people you know to see if they have any recommendations. Ask your family, friends, or another trusted healthcare professional if there is a primary care physician who may have the qualities you’re looking for.
If you have a specific health condition such as arthritis or diabetes, for example, you may wish to check with a group that specializes with that condition to see if they can suggest a primary care physician in your area.
Whether you take one of these routes or simply do your own research to try to find a primary care physician on your own, it’s beneficial to schedule an appointment with this practitioner to see what you think of him or her before assigning this role.
This gives you the opportunity to ask any questions you may have related to your care and the issues most important to you. It also allows you to see whether your philosophies are aligned.
If A Primary Care Physician Is Not Required
If you have Original Medicare or a Medicare Advantage plan that does not require that you choose a primary care physician—such as a Preferred Provider Organization (PPO) or Private Fee-for-Service (PFFS) plan—it is still important to see doctors, physician assistants, and/or nurse practitioners who accept your Medicare plan.
This is because these providers have agreed to work directly with Medicare to secure payment for any healthcare equipment or services you need. These are also the providers who have already agreed to the Medicare-approved amounts, which may potentially mean lower out-of-pocket costs for you.
If you’re unsure which healthcare providers accept Medicare in your area, Medicare.gov offers an easy-to-use online search you can do based on your geographic location. Simply enter your zip code, type “primary care” in the search box, and scroll down to select the option to see all primary care physicians in your area.
In your results, you’re provided a list of options in addition to the provider’s information (their name, facility name, physical address, and telephone number). This site also tells you if the doctor has a specialty, such as general or family practice.
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