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How To: Navigate Your Own Medical Care
do you know the difference between HMOs and PPOs?
Amber Welch || 3.4.2019
There are probably many things you remember about visiting the doctor’s office when you were young: playing with the other children in the cramped play area, leaping onto the scale without hesitation, creating wrinkles in the stiff white paper that covered the exam table, and being rewarded with a lollipop after surviving your routine vaccinations.
Visiting the doctor’s office as a child felt simple because our parents held the reigns over our medical care. But, as we began to age, our parents no longer accompanied us in the waiting room, and the exam table felt smaller and smaller as time went on. Things that they used to take care of for us (prescriptions, questions for the doctor, and the medical bills) are now our responsibility. And while of course it was beneficial for us at the time, our current state as twenty-somethings navigating the world of medical care on our own is like entering unmapped territory without much guidance.
According to a national poll conducted by the Kaiser Family Foundation in 2018, "45% of 18- to 29-year-olds had no primary-care provider, compared with 28% of those 30 to 49, 18% of those 50 to 64 and 12% 65 and older" in the United States.
For many young adults, deciding who will provide your primary medical care is not a top concern. Alternatives to primary care providers, such as walk-in clinics, provide a more budget-friendly option and same-day service that align with most of our income and schedules. With these easier options available to us, it is more possible to avoid gathering the necessary information about medical care.
With that said, how much do younger generations even know about medical care? Between hearing conflicting thoughts on The Affordable Care Act (Obamacare), the divide on Medicare and Medicaid, and surprise medical bills, navigating medical care can be tricky for anyone of any age. Hence, gaining a good understanding of the basics now as a young adult will allow you to know what options you have when it comes to medical care while balancing a busy schedule now and into the future.
Here are some basics to get you started in your healthcare 101 journey:
Many college students, graduates, and young professionals have it made by being covered under their parent’s health insurance plans. Bad news is that most coverage for children in the United States ends when you reach the age of 25 or 26, so planning ahead before your coverage ends is important.
Health insurance acronyms HMO and PPO are common, yet some young people might not be familiar with them. Health Maintenance Organizations (HMOs) refer to insurance plans that only give access to certain medical networks, doctors, and hospitals. This option can present lower rates but could mean costs of care will not be covered if it is done outside of your network. Unlike HMO, Preferred Provider Organizations (PPOs) allow you to see providers in the network that you choose. Additionally, you may see healthcare specialists without having to see a primary care physician first. This plan is definitely the more flexible of the two but can carry higher rates.
Since the type you have is often determined by your employer, you won’t actually have to choose between the two, but it is still important that you do further research on your own or discuss with HR so that you fully understand your coverage.
No health insurance? Although the open enrollment period has passed, Healthcare.gov still provides medical coverage for 2019. For those under 30 who are losing coverage, expecting a baby or getting married, you may qualify for a plan. If these circumstances do not apply, you may qualify for a Medicaid plan.
primary care physicians vs. alternatives
A primary care physician (PCP) is a doctor that understands aspects of general medicine and is usually the first stop when you need medical care. When you are facing a non-emergency, your primary physician usually performs your physicals, administers vaccinations, refers you to specialists, or orders tests that need to be conducted.
Compared to alternative options, having a primary care physician is expensive and presents time constraints. Most PCPs have their own hours and see numerous patients a day. Still, having a PCP—or someone that you see regularly and who understands your unique health history—is beneficial when it comes to preventative care and maintaining a healthy lifestyle.
Alternatives to PCPs include urgent care and walk-in clinics. Urgent care is a valuable option when you do not have a regular physician, especially since it is available at all times. PCPs and walk-in clinics may have certain hours or a particular doctor on vacation, so in a sense, urgent care may be the most convenient and reliable way to go because an emergency could occur at any time. The downside to that is that there is no guarantee that you will be seen in a timely manner. Plus, there are higher costs involved.
Walk-in clinics are fairly common (for example, your nearby walk-in clinic may be in your local grocery store or corner pharmacy). Walk-in clinics are a great alternative for those who do not have insurance and are suffering from minor illnesses or injuries. Though you do not need an appointment for a visit to the walk-in clinic, procedures are limited due to the availability of licensed physicians who have the authority to write prescriptions or handle emergencies.
With the conversation around medical care constantly evolving, understanding the basics of the concept should be considered a great first step. Of course, medical care comes at a high cost but with convenient options available (including improved access to providers via the use of telecommunication and information technology, plus other digital tools that promote wellbeing), medical care should feel accessible for every twenty-something.