A Primary Care Physician is Your Health Care Advocate

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Medicare Advantage (MA) plans provide greater flexibility in services available to older adults. That, of course, is a wonderful thing. However, it's essential not to lose track of core health care tenants, like the importance of having a primary care physician (PCP) to help individuals coordinate their overall health.

At one time, most MA plans were Health Maintenance Organizations (HMOs), which generally had specific networks that required customers to designate a PCP. Now, Preferred Provider Organizations (PPOs) are gaining in popularity. PPOs frequently feature broad nationwide networks and allow customers to visit in-network specialists without a PCP referral. Some PPOs may not even require the customer to have a PCP at all.

Even though a PCP might not be required, it's always a good idea for Medicare beneficiaries to have one to lead and coordinate their care.

A PCP can ensure older adults get the needed screenings for their age, gender and health status. A PCP can also help coordinate care between different health care settings and providers, including hospitals and specialists, to help speed the path to diagnosis and management of conditions, eliminate duplicative procedures and even prevent potential harmful medication interactions.

Sometimes, finding a PCP that matches your needs can be easier said than done. Doctors are aging just like their patients. As a result, older adults are seeking new PCPs, as ones they have trusted for decades have retired.

When replacing a PCP, it's important to allow them to step in as quickly as possible to ensure there aren't any gaps in care. Here are a few tips for finding a reliable PCP to meet an individual's needs:

Internists are doctors who specialize in internal medicine. Family medicine physicians specialize in family practice medicine. Both often serve as primary care physicians. Geriatricians are doctors focused on caring for older adults. Although not as common as internists, geriatricians can make excellent PCPs for people over age 65.

Talk to friends and family members, especially those around your age. Who do they recommend? Does their physician communicate well with them? Is it easy to get an appointment when needed?

There are a number of websites devoted to physician reviews by patients. They rate such things as promptness and bedside manner. Remember to use this information as only one tool in a decision-making process. Internet users also can visit Medicare.gov and enter their ZIP code to find physicians in their area who accept Medicare.

It's best to find a PCP near your home so it's easy to access care. Call local offices and ask plenty of questions. Where are they located? What are their hours? Are there others in the practice who provide care for patients, such as nurse practitioners and physician assistants? What are the local hospitals with which they are affiliated?

Call your insurer or visit their website to learn about physicians available in your plan and whether they are accepting new patients. If you go to a physician outside your network, it could cost you more.

Finally, while it's important to have a PCP, MA plans offer additional channels for customers to access care outside of regular business hours, such as telehealth or urgent care centers, depending upon the severity of the situation. After receiving treatment or diagnosis elsewhere, always follow up with your PCP.

Keep in mind that you have a much better chance of meeting your personal health care goals when you have a strong advocate in your corner who is helping to coordinate your health care needs. A PCP is that advocate.

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By Cigna Healthcare

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All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Some content may be provided under license. © 2022 Cigna