How to Get the Right Care at the Right Place and at the Right Time

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If you encounter a health issue outside of your doctor's regular hours, it can be confusing deciding what you need to do. Fortunately, there are many options available for timely, high-quality, safe and affordable treatment.

But how do you know which option is best for you?

This can be a challenge for anyone, but especially older adults, who may not be familiar with all the choices available, including the recent growth of digital or virtual solutions.

I'll highlight some of the considerations below, but let's start with the most important. There are some conditions for which the emergency room is the most appropriate level of care. If you think you are having a stroke or a heart attack, are bleeding uncontrollably, have suffered a head injury or are having a severe allergic reaction, call 911 or go to the nearest emergency room immediately.

However, there are many other conditions and symptoms for which alternative types and sites of care could save you time and money and still give you high-quality care. According to one study, two-thirds of emergency room visits are not for actual emergencies.

Home care is effective for people with multiple chronic conditions, particularly if they have difficulty with transportation. Some Medicare Advantage plans may even send clinicians to your home to help you with things like managing your diabetes. Home also is a good place to recover following a hospital stay or surgery. Some Medicare Advantage plans will help you by providing services such as home-delivered meals.

Your primary care doctor (PCP) will likely be your first call when a condition does not require immediate attention and occurs during regular business hours. Your PCP knows your medical history and can help to assess your needs. But when you need attention sooner, it can be a problem if there's not an appointment available for a day or so.

Outside of business hours, many insurers offer a nurse helpline around the clockat no extra cost. If you call this line, trained nurses can answer your basic health questions and help you decide the next steps depending on your symptoms.

Urgent care is for those conditions that don't require an emergency room visit, but for which you should probably be seen as soon as possible. This includes a host of conditions, such as bronchitis, cough, flu, nausea, sore/strep throat, upper respiratory infections, back or muscle pain, diarrhea, earaches, skin conditions, sprains, joint pain and even simple cuts or lacerations. Urgent care centers feature well-trained staff and many offer X-rays, laboratory tests and other diagnostic services. These facilities are usually open evenings, weekends and holidays. Services are easier on your wallet, too, with urgent care costs around one tenth the cost of a typical emergency room visit.

An increasing number of people use telehealth or virtual care to access health care in non-emergency situations. The Centers for Medicare & Medicaid Services expanded telehealth coverage during the COVID-19 pandemic, allowing beneficiaries to remain safely in their homes while receiving needed care. This coverage extends through 2024.

Some Medicare Advantage plans provide telehealth services through companies like MDLIVE at no additional cost. Health providers licensed in your state who work with these companies can evaluate you and prescribe most types of medications as needed. They may also offer access to behavioral health experts who can help with conditions such as anxiety or depression.

In addition to telehealth offered through insurers, many PCP offices offer their own virtual appointments, providing patients with routine care via telephone or digital solutions. Telehealth services are safe and private. And if you aren't comfortable using technology, you can always get help from a trusted family member to make the connection to a virtual provider.

When it comes to sites of care, don't forget your pharmacy. Many older adults take multiple prescriptions, and these medications can sometimes interact in negative ways. According to the U.S. Centers for Disease Control and Prevention, adverse drug events cause approximately 1.3 million emergency department visits each year. It's a good idea to keep a list of your medications (both prescription and over-the-counter) and talk to your pharmacist about any potential interactions.

One last tip. When receiving care in different settings, always remember to update your primary care physician about your visit, so they can be aware of any new diagnosis or medications. This will prevent duplicate and unnecessary tests, facilitate proper follow-up evaluation and protect you against potential adverse drug interactions.

Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. The Cigna names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE are owned by Cigna Intellectual Property, Inc. © 2023 Cigna Healthcare.

By Cigna Healthcare

Cigna Corporation (NYSE: CI) is a global health services company dedicated to improving the health, well-being and peace of mind of those we serve. Cigna delivers choice, predictability, affordability and access to quality care through integrated capabilities and connected, personalized solutions that advance whole person health. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth companies or their affiliates, and Express Scripts companies or their affiliates. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. 

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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