Enrolled in a Medicare Advantage Plan? How to Find the Right Primary Care Physician

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Having the right person (or team of doctors) can make a big difference in your overall health care.

If you’re enrolled in a Medicare Advantage plan, then chances are that your plan may operate as an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). And, while there are many nice benefits that you can reap from these types of health care entities, one thing that you will typically need to do is find a primary care doctor who is listed within the plan’s network of providers.

If your regular doctor is not listed in your Medicare plan, then finding a health care professional who will take over from him or her is essential – and locating the right person (or team of doctors) can essentially make a big difference in your overall health care going forward.

Tips for Finding the Right Primary Care Doctor When Enrolled in Medicare Advantage

One of the best ways to find your primary care doctor is to simply ask around. For instance, getting referrals from friends and / or family members can allow you to ask more in-depth questions about what they like (or dislike) about particular health care providers. With this in mind, though, it is also important to note that just because the doctor is a good fit for someone else, he or she may or may not be right for you and your specific needs.

Keeping your particular needs in mind can assist you in narrowing down the best provider. For example, everyone has personalized health care requirements. So, for instance, if you have been diagnosed with diabetes, you may find a primary care provider who has a focus in this area. By inquiring about what area(s) the physician specializes in, you could rule some out, while moving others up to the top of your list of possibilities.

Once you have a couple of viable candidates on your list, be sure that you check out where these doctors are located. Because you may be visiting your primary care physician on a regular basis, having someone who is close by can be much more convenient than having to drive a long way to see them.

It can also be a good idea to contact the provider’s office by phone. Doing so can immediately give you an impression of how helpful and courteous the staff members are. Likewise, setting up a personal visit with the doctor can allow you to take a first-hand look at their facility and to find out more about the other services that they may offer.
Going this route can also allow you to get a gut feeling about whether or not you will relate well to the doctor, as well as to determine just how much time they devote to their patients. In this case, ask yourself whether or not you feel comfortable taking with the doctor.

For instance, did he or she allow you the time that you needed to ask all of the questions you had on your list? Likewise, did they explain things in a way that was easy to understand (as versus bombarding you with a long list of medical jargon, which in turn left you confused)?

It is extremely important for you to be comfortable in working with your primary care medical provider. One key reason for this is because he or she will be the main “gatekeeper” to all of your other health care needs.
If you do choose a primary care provider who ends up not being the right fit, you can work with your Medicare Advantage plan in changing to a different provider who may be better for you and your health care requirements.

Need More Information?

Medicare plans can be somewhat confusing. There are many “moving parts” that go along with Medicare’s coverage options. So, it can be beneficial to ask questions if or when something isn’t quite clear.
One good way to speak directly to an insurance professional who is a specialist in Medicare health care plans, or your health insurance plan directly.

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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.