After you sign up for a Marketplace health plan, you will want to choose a primary care provider. This is the main person who will provide you with and help you access a range of health care services so it’s important to spend time making this decision. You want to make sure your primary care provider will listen, answer your questions, and advocate on your behalf. So how do you choose someone that will be a good fit? In this article, we’ll answer questions you should consider when choosing a primary care provider for you and your family.
What does a primary care provider do?
Your primary care provider is your first point of contact for medical care. This person will diagnose and treat any common healthcare problems, conduct routine diagnostic screenings, and help you develop a healthy lifestyle. This is also the person you will go to for routine check-ups, vaccinations, or get a referral from for a specialist. Essentially, your primary care provider is your partner in health and wellness.
Are primary care providers always MDs?
No. The Affordable Care Act recognizes the unique benefits offered by a range of professional providers. Depending on your state regulations and the policies of your health plan, you may be able to choose a nurse practitioner (NP), physician’s assistant (PA), doctor of osteopathy (DO), or naturopathic doctor (ND) as your primary care provider. When your primary care provider is a physician, you can choose between a family practice doctor, an internist (general adult health), a pediatrician, a geriatrician (elder health), or an obstetrician-gynecologist. Each person in your family can also have their own primary care provider.
What should I consider when choosing a primary care provider?
When choosing a primary care provider, you want to make sure it’s someone you will feel comfortable with long-term. For help with your decision, you can ask for a referral from a friend, family member, or coworker. Another option is to ask for a recommendation from a health care professional you already know and trust.
Sometimes it’s even possible to schedule a short, free or low-cost interview with a potential primary care provider. During the interview, you can get a better idea if their health care philosophy (medical interventions, preventative care, communication) aligns with yours. The Wall Street Journal even suggests the importance of finding a provider who is “competent, caring and connected“.
Pro Tip: You can also use HealthGrades to research and compare doctors and hospitals.
Does my primary care provider have to be on a provider list?
Yes. Your primary care provider is at the heart of your medical care so it’s important to choose someone who is within your network. If you already have a provider in mind, you can always contact their office to find out if they accept your coverage. If you’re assigned a provider, you should still do some background research to make sure they will be a good fit. Otherwise, you can contact your plan to request a change.
How do I find an in-network primary care provider?
Your health plan has a list of providers, along with their specialties, addresses, and a notation of whether they are currently accepting new patients. If you’ve signed up for health insurance through HealthSherpa, you can find these tools in your Consumer Dashboard. If you didn’t sign up through HealthSherpa, the easiest way to locate this list is on your health plan’s website. From there you should be able to locate a link that will bring you to a list of providers. You can also phone your health plan and simply ask for the names and contact information of the practitioners located near you. Once you find an in-network primary care provider, the last step is to contact the practitioner’s office to confirm all online details are up to date and that they are accepting new patients.
Do you need help choosing a primary care provider? Our licensed brokers would be happy to help you understand your in-network options. Call us today at (855) 772-2663.