Questions & Answers

Choosing a Doctor & Insurance   


Good medical care does not happen by accident. It is important to have a doctor who knows you and your health problems and who understands the special health care needs of older people. A personal physician, or primary care physician, can help you make medical decisions and can oversee the care you get from specialists.

Choosing a doctor is one of the most important decisions you can make. It's a decision that is probably best made while you are healthy and have some time to think about a number of possibilities. If you don't have a doctor or are thinking about changing doctors, now may be the best time to look for one. The following ideas can help you in your search for a doctor who is right for you. 

What should you look for in a doctor?

Many personal likes and dislikes are involved in choosing a doctor. In general, you want a doctor who is well trained and competent. You also want a doctor who cares about you, who will listen carefully to your concerns, who can explain things clearly and fully, and who can anticipate your health problems. Other things that might affect your choice of a doctor include the type of health insurance you have, the location of the doctor's office, the hospital where the doctor treats patients, the age and sex of the doctor, and the languages the doctor speaks. A good first step is to make a list of the things that matter to you. Then, go back over your list and decide which are most important and which are nice, but not necessary. 

What type of doctor is best?

You might choose a family practitioner, an internist, or a geriatrician. Family practitioners provide health care to all family members, regardless of age. An internist is a doctor of adults. Some internists take additional training to become specialists; for example, cardiologists are internists who specialize in diseases of the heart. Geriatricians specialize in the care of older adults. A geriatrician first is trained in family practice or internal medicine and then has additional training in caring for older people. 

How does managed care affect your choice of doctors?

Most people who are 65 or older are eligible for Medicare hospital insurance (Part A). Almost anyone 65 or older also can enroll in Medicare medical insurance (Part B) by paying a monthly fee. Medicare medical insurance helps pay for doctors' services and many other medical services and supplies that are medically necessary but are not covered by the hospital insurance part of Medicare. 

Medicare beneficiaries can choose how they will receive doctor, hospital, and other health care services. Many older people use the original fee-for-service health insurance program. Under this program, you may see any doctor or health care provider you choose. You usually pay Medicare's deductible and coinsurance and any other charges not covered by Medicare. Medicare pays the rest. You are responsible for handling bills and payments. 

Some older people are choosing Medicare managed care plans. When you enroll in a managed care plan, you select your doctor from a list of primary care physicians who are part of that plan's network of doctors. Your primary care physician then is responsible for coordinating all of your health care needs. If you do not choose a doctor, you will be assigned one. In some plans, you can see a health care provider outside the network, but it will cost you more money. You may be required to pay a small copayment for some services and visits.

Today, there are many different kinds of managed care plans with varying benefits, costs, and rules. Be sure to compare each plan and consider each type of insurance (fee-for-service and managed care) carefully to make the choice that is right for you. 

For more information about Medicare benefits, you may call any Social Security Administration district office or the Medicare hotline at 800-638-6833. You also can learn more on the Internet about Medicare at 

Can help you find a new doctor?

After you have a general sense of what you are looking for in a doctor, ask relatives, friends, coworkers, and other health professionals for recommendations. If possible, ask about the person's experiences with the doctor. For example, 'What do you like about Dr. Smith?' A doctor whose name comes up often might be a strong possibility. It may be helpful to have several names to choose from, in case the doctor you select is not currently taking new patients or does not participate in your health insurance plan. 

If you belong to a managed care plan, you can get a list of doctors from the plan's membership services office. Your choices will be limited to those doctors affiliated with the plan. 

If you need more help finding names of doctors, contact your local medical society, local physician referral services, nearby medical schools, and university medical centers in your area. 

How do you make an informed choice?

Once you have chosen two or three doctors, call their offices. The office staff often are a good source of information about the doctor's education and training, office policies, and payment procedures. You may want to set up an appointment to talk with a doctor. Make sure that he or she knows that you are trying to decide on a doctor. You may be charged for such a visit. 

Board certification is one way to tell about a doctor's expertise. Doctors who are board certified have had training after medical school and have passed an exam certifying them as specialists in certain fields of medicine. These include the primary care fields of family practice, internal medicine, and geriatrics. 

You may have a number of questions to ask the new doctor. For example, does the doctor see many older patients? What are the doctor's views on health and aging? What does the doctor think about preventive care for older patients? Does the doctor encourage patients to ask questions? Does the doctor involve patients in care decisions? 

Why is the first doctor's appointment so important?

After choosing a doctor, make your first appointment. During this visit, the doctor will probably take a medical history, which will include questions about your current and past illnesses as well as any illnesses in members of your family. The doctor also will perform a physical examination. Be sure to bring your medical records (or have them sent) and a list of your current medicines, including those that you take without a prescription. If you haven't talked with the doctor beforehand, take time during this visit to ask any questions you have about the doctor and the practice. 

After the appointment, ask yourself whether you feel comfortable with and have confidence in this doctor. For example, did you feel comfortable asking questions? Did you get answers that you understood? If you are not satisfied, schedule a visit with one of the other doctors on your list. 


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