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How to choose a health plan

Health plan home | Health-care models | Choosing a health plan | Choosing a doctor | Helpful hints


Selecting a new health plan often means selecting a new doctor. Finding the right physician is essential to your satisfaction with whatever health-care plan you choose. Except in rare circumstances, once you select a plan and a primary care physician, most companies will not let you change until the next open enrollment period. As with your choice of health plans, the more informed you are when choosing your doctor, the happier you will be with your decision.

The Primary Care Physician

Most health plans require that you select one doctor from its network to serve as your main or primary care physician (PCP). These doctors offer comprehensive medical care and also have different specialties such as family practice, internal medicine, and pediatrics. Some plans even have OB/GYN (obstetrics/gynecology) doctors as primary care physicians. Having a primary care doctor will help ensure that all your medical records are in one place, your treatment will have continuity, and you will have someone who knows your medical history when referring you to specialists.

Open Enrollment Period

A time during which subscribers in a health benefit program have an opportunity to re-enroll or select an alternate health plan being offered to them, usually without evidence of insurability or waiting periods.

Common Questions About Selecting A Primary Care Physician

Q: How do I know which doctors are available to me?

A: Just ask for a copy of the most recent provider directory from your health plan or participating physician group to find a doctor in your area.

Q: Which hospitals can my doctor admit me to?

A: Most doctors are affiliated with certain hospitals. If there is a hospital you prefer, check to see if your doctor works with that facility. Your health plan provider directory should list this information.

Q: Which kind of primary care doctor will best meet my special medical needs?

A: An advantage of primary care doctors is their ability to provide care for a broad range of patients. At the same time, their practices may have special areas of emphasis, so it is important to find out if their background meets your particular needs.

Family Practice doctors (Family Physicians) offer general family health care for all ages. They may be a good choice for someone wanting one doctor who can care for the whole family.

Internal Medicine doctors (Internists) provide medical care to adults and adolescents. They are especially effective in treating chronic conditions such as hypertension and diabetes.

OB/GYN doctors specialize in obstetrics and gynecology. They have training in women's reproductive issues from childbirth to menopause. (Not all plans offer OB/GYN doctors as primary care physicians.)

Pediatric doctors (Pediatricians) specialize in children's health care and have training in child development from infancy through adolescence.

Q: Does my doctor have access to programs to help me improve my lifestyle?

A: Today, most larger health-care organizations emphasize wellness programs that teach you how to eat well, exercise, stop smoking, and screen for early warning signs of illnesses. Ask if your doctor and hospital are affiliated with this kind of program.

Here are some additional questions to consider when making your decision:

  • Do you wish to see a doctor in a traditional private practice setting or one in a health center with lab, X-ray, and other services on site?
  • Do you want one PCP for the whole family or have all your family's doctors in the same location?
  • How long does it normally take to get an appointment for routine care?
  • How long does it take to get an appointment when you are ill, but not in an emergency situation?
  • If you choose a physician group, are you able to see the same PCP each time you schedule an appointment?
  • If you require hospitalization, does your PCP admit you and manage your care?
  • Who covers for the physician during vacations?
  • How accessible is the physician in emergency situations?