Having a primary care physician you can trust who is also someone you are familiar with is one of the best ways in keeping you and your family healthy. Many new immigrants run into complications when purchasing their first health insurance policy in the United States and end up choosing the wrong physician.

With that being said, we’re here today to help you and your family stay healthy by giving you some tips on how to choose a good primary care physician!

What’s HMO and PPO?

When purchasing health insurance, one of the first decisions you come across is choosing between HMO and PPO. 

HMO (Health Maintenance Organization) means that you must first designate a PCP (Primary Care Physician) for any minor illnesses you may have such as headaches or getting a cold. If you need to see a specialist, then you would need to go to your PCP for a referral. Because everything goes through your PCP, HMO is generally cheaper.

With a PPO (Preferred Provider Organization) plan, you don’t need to designate a PCP. As long as you see doctors that are within the contract and the medical network, then you will be able to visit those doctors. Since there are more options, PPO plans are generally more expensive. Some still recommend choosing a PCP just to make it a little bit more convenient.

PCP Quick Guide

Your primary care physician is the one that knows your health the best—especially after taking care of you all these years. It’s important that you don’t wait until you’re sick to choose a primary care physician. It’s recommended to choose your doctor while you’re in the process of figuring out your health insurance so that you can take your time in choosing a good doctor. By the time your insurance becomes effective on January 1st, you will be able to use your health insurance without any worries!

The Different Types of Physicians

The kind of doctor you’ll see will vary based on your medical needs. Every member of your household can have different primary care physicians. You might also have different kinds of physicians throughout different stages of your life. For example, as a child, you would see a pediatrician; adults with chronic illnesses such as kidney and lung diseases would see a doctor who specializes in internal medicine; and the most common is the family practice/general practice doctor that takes care of both adults and children in minor illnesses such as the common cold and much more.

Factors to Consider When Choosing a PCP

Building a caring and trusting long-term relationship with your doctor is vital to receiving the best care for you and your family’s health. You can ask for suggestions from your family and friends, or ask for recommendations from your previous doctors that you know and trust.

One thing you need to know is that not all family doctors accept new patients. With that being said, it’s important to confirm whether or not the doctor you want to see is still taking new patients during your consultation.

With an HMO plan, you must choose a doctor that is within 30 miles of your residency. For example, if you used to live in Monterey Park but now live in Rancho Cucamonga, which is more than 30 miles away, you will no longer be able to see the doctors you used to see back in Monterey Park.

The first encounter you have with your family doctor is your chance to get to know your doctor as well as share with your doctor information about you, including your health status/condition, medical history, family history, lifestyle, beliefs, etc. It’s important that you and your doctor are on the same page, in terms of health, preventive health care, and effective communication, including speaking the same language, and more.

PCP, Medical Network, and Health Insurance

For HMO, on top of choosing a primary care physician and a medical network, each insurance company has its own different contracted physicians and medical networks. Once you choose a health insurance plan, then you will have to choose a doctor that is within the medical network contracted to the health insurance plan.

Many individuals in the Chinese community choose the Allied Pacific network because there are a lot of Chinese speaking doctors so if you need to see a specialist, it’s also pretty convenient.

In 2018, Blue Shield and HealthNet are both now a part of Allied Pacific so if you choose an HMO plan, it will be even easier to find a Chinese speaking doctor.

Typically, you would receive a Member ID for your new health insurance policy within 1-2 weeks of applying for health coverage. This allows you to register on the site and choose your PCP and medical network. But of course, please always feel free to contact KCAL’s certified health agents and they can help you choose a PCP and medical network ASAP!

There’s Still One More Super Convenient Option Out There!

First there’s choosing a family doctor, then there’s making sure they’re in the medical network, plus referrals, it’s way too much trouble! It’s a little frustrating having to deal with all of this right? We get it! There’s actually another option out there—Kaiser Permanente. Kaiser is different from other health insurance companies because not only does it have its own healthcare, but it is also a medical center. It’s a one stop shop! Its medical system is similar to that of Asia. Under a Kaiser HMO plan, you will be able to find doctors under Kaiser, especially many Chinese speaking doctors. Kaiser has also become the number one health insurance choice for many immigrants.

It is currently Open Enrollment Period! If you want your insurance to be effective on January 1, then you must apply by December 15. The final deadline to enroll in health insurance is January 31, 2018. Whether it’s switching your insurance policy or enrolling into health insurance for the first time, you can’t miss the January 31st deadline. Do not miss the once in a year opportunity to enroll in health insurance!