One key component of a health maintenance organization (HMO) health insurance plan is the primary care physician (PCP).¹ This is the person who will coordinate all of your medical care. You will likely be required to choose a primary care physician when you sign up for your insurance. This is an important decision, so carefully consider your options.

Many Medicare recipients choose HMOs for their health insurance. In fact,  62% of Medicare Advantage recipients have HMO plans.² HMO plans can also be offered by employers³ and are available on the health insurance Marketplace.4 If you’re not sure what kind of plan you have, check out HealthMarkets’ descriptions of common insurance terms for a brief overview.

Do you already have a doctor that you’d like to continue to use? If so, make sure that this person is in the network for any health insurance plans you might be considering. If you don’t have someone you prefer, how can you find a doctor you like? HealthMarkets suggests using these guidelines to narrow your search.

Find an Office

You don’t want to drive far to see a doctor, especially if you aren’t feeling well. Make a list of doctors’ offices that are close to your home. Are they convenient? Are they open on weekends? Look at their office hours to make sure they are available when you are. Call a few of the places that fit your needs, and ask if they’re taking new patients. If they are, see how soon you can get an appointment. You don’t want to have to wait several weeks to see your doctor, so lack of availability is a warning sign that you may want to choose a different office.

One of the best ways to find an office and/or PCP is by asking your friends and neighbors. Many people are eager to share both positive experiences and horror stories about local doctors. You can also look at ratings websites or online community forums for suggestions.

Consider Your Needs

You may be tempted to just pick a name out of a hat and go with it, but this is one of the most important health care decisions you’ll make, particularly if you fall ill. All of your healthcare will be arranged and directed through your primary care physician, and you’ll need to see that person if you want referrals to specialists or anything out of the ordinary.

Once you’ve found one or two offices that meet your needs, consider the type of person you feel most comfortable with. Do you want someone fresh out of medical school? Would you prefer an older doctor? Do you have a gender preference? You will likely be discussing intimate issues with your doctor, so you want to feel comfortable with him or her.

Interview Two or Three PCPs

If you have the ability, make an appointment to meet with the PCPs you are considering. Before you speak to a potential PCP, think about the issues that are important to you. Perhaps you have some particular health concerns. Maybe you are a fan of one kind of diet, or a certain type of exercise. Ask the doctor what his or her thoughts are on these subjects. Your primary care physician should be someone that makes you feel confident and comfortable. Don’t settle for anything less.

Once you’ve found the primary care physician you’d like to use, visit HealthMarkets online to find plans that have your doctor in their networks. The HealthMarkets FitScore® can rank plans based on your needs and can help you find a health insurance plan that includes the doctor you want to use. The best part? The service comes at no cost to you.

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References
  1. Health Maintenance Organization (HMO). Medicare.gov. Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/health-maintenance-organization-hmo. Accessed December 16, 2020.
  2. Kaiser Family Foundation. Jun 06, 2019. Retrieved from https://www.kff.org/medicare/fact-sheet/medicare-advantage/
  3. “HMO Market Penetration And Costs Of Employer-Sponsored Health Plans.” Health Affairs. October 2020. Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.19.5.121?journalCode=hlthaff
  4. Health insurance plan & network types: HMOs, PPOs, and more. HealthCare.gov. Retrieved from https://www.healthcare.gov/choose-a-plan/plan-types/
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