Primary care physicians: Your access to thousands of dollars in free care
As you’re getting settled in with your new health insurance plan, one of the most important decisions you have to make is: who is my primary care physician (PCP)? Don’t be lazy when choosing a PCP this year – your health and wallet are at stake! Getting health care peace of mind revolves around finding a PCP you respect and like. Here are some tips to help you get there.
1. What is my PCP’s role in the healthcare system?
Your PCP exists to monitor your health and detect abnormalities before they become serious. Most importantly for your wallet, they allow you to access heaps of free preventative care that is provided under Obamacare. For example, a free well-woman checkup can be worth as much as $500. Free care for a man with high cholesterol and blood pressure could total close to $1,000 (see detailed breakdown of free care for these scenarios at article bottom).
2. Does my plan type (HMO, EPO, PPO ) affect my primary care selection process?
HMO and EPO plans require referrals to see specialists, so you absolutely need to choose a PCP. Some plans automatically assign you a PCP, while others will have you choose.
If you are automatically assigned a physician, switch if you are unhappy. As long as your desired doctor is in-network, you can call your insurance company and request a PCP change. This change could be effective immediately, or you may have to wait until the 1st of the following month. Please contact our Health Concierge team if you need help changing your PCP.
PPO - With a PPO, you don’t need a referral from your PCP to see a specialist. However, it’s invaluable to run your medical decisions through one provider that knows your comprehensive medical history. Even under a PPO plan, regularly seeing a trusted PCP will help you evaluate potential treatment options and avoid unnecessary (and costly) specialist appointments/tests. And remember: your PCP is the only access point to your free preventative care and screenings included with your health plan.
3. How do I find the best PCP for me?
If you are shopping for a plan and already have a PCP, enter the name of your physician on Stride and our recommendation engine will present a plan that includes your doctor; if you need to choose a doctor on your new plan, use our doctor search to find one that is in-network.
Make sure your PCP is accepting new patients. This will ensure you can get an appointment quickly and can immediately begin using your insurance. The major health insurance companies have search tools that allow you to find only doctors accepting new patients. You can also call a doctor’s office directly and ask (or we can do it for you!)
Find a quality physician. Look for board certified physicians that are affiliated with hospitals, clinics, or physician’s groups close to your home. Get recommendations from friends and family, or visit doctor ratings websites. Use these with caution, as every patient’s experience is unique, and you might prefer a different style of doctor than the person writing the review (Healthgrads, RateMds, Vitals ). And remember, you can always switch your PCP if you are unhappy.
4. Utilizing your PCP can save you thousands in medical bills
Even if you don’t have an immediate need to visit the doctor, choosing your PCP now is super important. Once you’re sick and need an urgent appointment, you don’t want the added stress of finding a primary care provider.
Many patients who don’t choose a PCP early in the year end up turning to Emergency Rooms or Urgent Care centers for medical issues that could have been treated in a doctor’s office. This ends up being really expensive for you… the average ER visit is $1100!
[If you end up needing same-day, non life-threatening medical attention, consider urgent care – average cost of a visit is $150]
5. How much will visiting my PCP and getting my free preventative care cost me?
Under Obamacare, everyone gets a free annual physical from their primary care doctor. No copays, no coinsurance – one free visit, one free physical.
After that, you must look at your insurance plan and identify your benefits. Some plans will allow unlimited PCP visits for a $20-40 copay per visit. Some plans will give you the first three PCP visits for $20-40 copays, then charge you full cost after that. If you have any questions about reading your plan coverage, pleasecontact our Health Concierge team.
6. Get all of the free care you deserve – plan out your free, preventative care using Stride
This is very important: your age and medical history dictate what free preventative care you have access to. Therefore, it’s important to be informed before talking to your PCP. Stride helps you get the most out of your insurance by planning out your visit with your PCP. From your Stride dashboard, you can create a personalized visit plan that maximizes the free preventative care offered to someone with your age and medical history. Take this visit plan to your office visit, so you have easy access to your personal health information.
Whether you’re healthy or not, or purchased an HMO, EPO, or PPO plan, your PCP is your access to thousands in free care… not to mention getting ahead of any medical issues before they become larger problems. Find a high-quality PCP and plan your visit today!
Average cost of free care received during a well-woman visit for a 25 year old woman in good health:
Chlamydia Infection Screening $61 Contraception $310 Gonorrhea Screening $56 Sexually Transmitted Infections counseling for sexually active women $42 Cervical Cancer Screening $45
Average cost of free care received during a physical exam for a 50-year-old man with high blood pressure and high cholesterol:
Cholesterol Screening $51 Blood Pressure screening $66 Colorectal Cancer Screening $749 Diabetes Screening for adults with high blood pressure $22 Obesity Screening and counseling $95