Five Tips to Find a Good Primary Care Physician under Obamacare

Everyone needs a good primary care physician, but it’s not always easy to find a doctor that’s right for you. Everyone has different ideas about what makes a good fit, whether it’s a convenient office location or a doctor who understands you and any physical issues you may have. To ensure that you consider everything that may impact your decision, we’ve compiled some helpful information and tips to guide you while trying to find that perfect match.

What is a primary care physician?

First off, you may be wondering what exactly a primary care physician is and how he or she may differ from other doctors you visit.

Your primary care physician (also known as a PCP) is your first contact when you have any routine medical issue – an annual check-up or physical, when you’re feeling under the weather and may need a prescription, or have a minor injury that doesn’t require an emergency room visit. Each member of your family may have a different primary care physician, or you may all share one. Generally, a primary care physician will specialize in internal medicine or family medicine; he or she may be a general practitioner or a pediatrician, if they see children only. In some cases a nurse practitioner may also be a primary care physician.

Depending on the type of Obamacare health insurance plan you have, you may be required to select a primary care physician. For example, most HMO-style health insurance plans will require you to select a primary care physician, while most PPO-style plans will not. Your HMO plan uses your primary care physician as your first line of defense and as a “gatekeeper” to other network medical specialists when you need different kinds of medical care. With an HMO, your primary care physician generally needs to give you a referral to see other doctors for specialist care.

Though the term “primary care physician” has a specific meaning for those covered under HMO-style plans, anyone’s main doctor can also be loosely referred to as their primary care physician. Most people will change their primary care physician at least once throughout their lifetime, such as when moving from a pediatrician to someone specializing in adult medicine. Other people change their primary care physician frequently.

Obamacare and primary care physicians

Obamacare, the law officially known as the Affordable Care Act, made no major changes to the ways that consumers or health insurance companies utilize primary care physicians. HMO-style plans still exist, requiring many people to choose primary care doctors. People enrolled in other plans still frequently choose a main doctor that they stick with, often for years. That said, the networks of doctors covered by different health insurance plans can change even under Obamacare:

• Most health insurance companies utilize specific networks of medical providers and encourage their members to see doctors within that network in order to keep costs in check.
• Insurance companies may change their provider networks each year, so this is something to watch out for.
• Doctors may also opt out of specific insurance company provider networks at any time of the year.
• If this happens to you, you’ll need to look for a new primary care physician.

Five tips to help you pick a new primary care physician

We’ve compiled a list of tips to help you in selecting your primary care physician under Obamacare. Consider these tips a starting point. Hopefully they can help you in your decision-making process.You may also find this short video useful:

• Ask for a personal recommendation

Friends, family and co-workers will always know you best. And you know which friends may have preferences similar to yours. Selecting a primary care physician is an important choice so it’s always wise to talk with those who will tell you their honest opinions when picking a new physician. If you have any specific health needs, co-workers, neighbors or others you respect in a similar situation are good candidates to get opinions from. Also, if your present doctor is retiring, he or she can be an excellent resource in finding a new physician since they already know you and your medical needs.

• Work with the insurance company to see which doctors are in the network closest to you

You probably don’t want to travel too far to see your primary care physician. Most insurers have websites or toll-free customer service phone lines that can help you locate a primary care physician that is close to either your home or place of work (or some other location important to you). Generally, most will also tell you whether or not a specific doctor is presently accepting new patients.

• Read personal statements or reviews of the doctors you’re considering

The doctor may have a personal website, which is a good place to start for general information. The physician may also belong to a hospital or clinic which has personal web pages for each doctor, providing detailed information on their education, background, years of practice, and areas of special medical expertise. Online research will help you find additional information on the doctor you are considering. Your state’s medical board will help you with information on the doctor’s present standing with the state. You may also be able to find customer reviews of specific doctors online as well.

• Confirm the doctor’s network status

If you’re considering a doctor based upon a personal recommendation or other factor such as location, confirm that the doctor is part of your Obamacare health insurance plan’s network by visiting your insurance company’s website. You should also double-check by asking the doctor’s office. A doctor’s network status can change and not yet be updated on your insurance company’s website. Make sure that the doctor is indeed in the network and not simply willing to bill your insurance company. Network doctors are generally contractually obliged to accept a discounted rate as payment in full for covered medical services.

• Go ahead and make an appointment

This one gets a little complicated. If you have an HMO-style health insurance plan, you may need to designate a doctor as your primary care physician BEFORE you can schedule an appointment – but remember that you can generally change your primary care doctor any time you wish.

Either way, as a general rule, it’s better to find a new primary care physician before you’re sick. By planning ahead you won’t be in a rush to pick one when you need immediate medical care and just want to get into the doctor’s office to feel better.

If it’s been a while since you had a checkup, schedule one with the doctor you’re considering, or see him or her when you’re feeling under the weather if you’ve already had a checkup this year (a second one may not be covered in the same year by your insurance company).

After the appointment, ask yourself:

• Did the doctor listen to me?
• Did the doctor take an interest in my personal medical history or condition?
• Did I feel comfortable talking openly with this person?
• Did I feel comfortable with the doctor’s apparent level of expertise?
• If the answer is yes to these questions, then you may just have found yourself a new primary care physician!

In closing: finding your primary care physician under Obamacare

Selecting a primary care physician under Obamacare is an important choice, and may also be a required choice based on your health plan. This is going to be the main individual you are tasking with taking care of your personal health or the health of your family. Making an informed decision will put you at ease in knowing that that the physician you’ve selected has your best interests at heart.