How to Talk to Your Doctor About Stress & Anxiety

We all feel stress and anxiety from time to time; it’s a part of the human experience [1]. But, when your stress and anxiety start to take a toll on your mental wellbeing and prevent you from feeling content in your everyday life, it’s smart to speak with a professional about it. Therapists and psychiatrists are trained to tackle mental health issues like these, but your primary care doctor can also be a great resource to speak to about your concerns. They can address your feelings in relation to your health history, and can help diagnose a potential condition, make treatment recommendations, and provide advice on dealing with stress and anxiety [2]. They can also direct you toward a mental health practitioner who would work well with your needs. Although you may be hesitant to bring up your mental health at your next primary care appointment, keeping this a secret is never the right path. Sharing your struggles and asking for help is a sign of strength and taking control over your health.

Prepare for Your Doctor’s Appointment

If you’ve been experiencing a lot of stress and anxiety in your day-to-day life, your mind likely feels overwhelmed. Maybe it’s full of racing thoughts that never seem to halt. Or, perhaps you’re so overwhelmed by your emotions that your head feels cloudy and numb. Whatever you are feeling, know that talking about it is the first step in getting the help you deserve. Prepare for your doctor’s appointment by writing down your feelings as they arise, instead of depending on your memory at the actual appointment.

Stress and anxiety can fluctuate [3], and you may be feeling great the day of your appointment. Because of your calm mood, you may simply forget about all the hard times you’ve been having lately and push this matter under the rug. By preparing ahead of time and writing down how you feel when you are anxious and what triggers your stress, you have something concrete to reference during your appointment.

Think about when your anxiety and stress arise most often—is it in the morning, right when you wake up? Is it at night while you lie in bed? Or, is it throughout the work day? Additionally, note some of the sensations that come with these feelings. Do you experience a fast heart rate, sweaty palms, or shortness of breath [4]? Or, maybe you feel dizzy, unable to concentrate, or panicked [5]? These can all be symptoms of mental health conditions that your doctor should be made aware of.

Questions to Ask Your Doctor About Anxiety

Before you speak with your doctor about your anxiety and stress levels, write down a list of questions that may help you gain the clarity you need. Remember, your doctor is trained to help you understand your feelings and address your concerns. Never hesitate to share your thoughts and questions, and don’t worry about asking too much. There’s no such thing as too many questions at the doctor’s office! Some ideas for questions include:

“Is it possible I have an anxiety disorder? What type of anxiety disorder could this be?”
“What are the possible causes of what I’m feeling?”
“What are my treatment options?”
“Are there any lifestyle changes that might help?”
“Should I see a specialist, like someone who focuses on mental illness?”
“What are the potential side effects of any medications you might recommend?”
“How often will we check in on how I’m feeling?”

Your doctor’s responses will help you gain insight into your potential condition and will likely help you feel more comfortable navigating it moving forward. They may be able to recommend specialists you should speak to or guide you through some lifestyle adjustments that may help alleviate your anxiety.

Stay Connected With Your Doctor

It’s important to find a doctor with whom you feel comfortable talking about vulnerable topics, like mental health. Your primary care physician is a great starting point, especially if this issue is new to you and you already feel fairly comfortable with them. However, you should also feel inclined to ask for referrals to mental health specialists who can provide more in-depth care and expertise on your condition of concern. Your primary care doctor will likely be able to help you recognize whether your feelings indicate an anxiety disorder and introduce some lifestyle habits or medications that may help, which may feel like enough for you. But, many individuals may require more extensive care, especially if your condition is more severe [6]. A mental health practitioner specializing in anxiety can provide many more resources and a deeper understanding of the condition.

Whether you are seeing your primary care physician or a mental health specialist to care for your mental health, one thing is key for success: communication. Ongoing communication, follow-up appointments, and honesty are important parts of managing your conditions effectively. This will help you get the most out of your appointments.

Understanding Diagnosis and Treatment Options

The diagnosis and treatment journey may feel daunting at first, but it’s a necessary path for caring for your mental health. Fortunately, your healthcare provider will be there for you every step of the way. In this section, we’ll outline the common process of diagnosing and treating anxiety.

The journey to diagnosis typically starts with a conversation between you and your primary care physician about how you’ve been feeling and potentially having your provider administer a questionnaire such as the GAD-7. From there, if they feel like your experiences may indicate an anxiety disorder, your primary care provider can diagnose and treat your anxiety or they may refer you to a mental health specialist [7]. Your first appointment with your mental health specialist is called an intake appointment [8]. In this appointment, the specialist will conduct a psychological evaluation. This may sound scary, but it only involves a more detailed conversation about your symptoms, your family history with mental health conditions, and how much your symptoms are affecting your life [9]. Your specialist will consider your responses and schedule a follow-up appointment to discuss your diagnosis, if any. From there, the two of you will discuss whether you’d like to move forward with therapy, or possibly medication, if they see fit. Remember, psychiatrists mostly deal with prescribing medication (though they may provide some therapy) and therapists mainly provide counseling [10].

Treatment can look different for people. It all depends on the severity of your condition and what helps support you the most. For many, therapy helps work through emotional blocks, finding the root cause of your issues and learning healthy coping mechanisms. There are many types of therapy focusing on different methods of improving your mental health. Some of the most common types of therapy for improving anxiety include Cognitive Behavioral Therapy (CBT) and Exposure Therapy [11], but there are many other modes of therapy that may be successful.

Your specialist may recommend that you consider taking medication to lessen your symptoms of anxiety. Anxiety disorders can be caused by a chemical imbalance in the brain, and medications like Selective Serotonin Reuptake Inhibitors, or SSRIs, can help balance out the hormones contributing to your symptoms [11]. Although many may feel hesitant to take medication for their anxiety, studies found that medication intervention was more successful than psychotherapy alone for treating mental health disorders [12].

Another treatment method your specialist will recommend is changing unhealthy lifestyle choices. Factors like poor diet, lack of exercise, and not getting enough sleep can contribute to mental health issues [13]. Therefore, your specialist can help you create a plan to improve on these lifestyle choices.

No matter what treatment path you end up taking, make sure to consistently communicate with your doctor and specialist about what is and isn’t working.

Struggling with mental health issues like stress and anxiety can be extremely difficult, but you don’t have to go through it alone. Your doctor is there to provide insight, advice, and referrals to help improve your mental health and support you throughout your journey. Preparing ahead of your appointment can help you feel more confident during your conversation with your doctor, and ensure you don’t forget any important points you wish to address. Remember, the end goal is to work with your doctor as a team and find a treatment plan that works best for your needs. Book an appointment with Greater Good Health today if you’re a senior who would like to discuss symptoms of anxiety and stress.

References Used:

The Future of Primary Care: How AI and Telehealth Are Transforming Medicare Services in 2025

In our ever-changing landscape of technology, Artificial Intelligence (AI) has become a valuable asset in the world of healthcare, telehealth, and Medicare. AI has improved healthcare in a multitude of ways, including making diagnosis, treatment, and patient-care more efficient and user-friendly. In this blog, we’ll dive into how AI and telehealth are transforming Medicare services in 2025, and what these changes mean for you and your services.

The Rise of Telehealth in Medicare

“Telehealth” is the use of technology to assist with healthcare services for patients and healthcare providers [1]. At one point in time, in-person appointments may have been the only option available, making healthcare services difficult to attain for some individuals. Now, telehealth is the new norm—and healthcare services can be accessed from the comfort of your home through the use of technology.

The use of telehealth rose during the COVID-19 global pandemic, as patients weren’t able to visit doctor’s offices to receive services due to social distancing protocols. In fact, there was a 154% increase in telehealth visits during the last week of March 2020 compared to the same period in 2019, which illustrates the degree of this rise [2].

The growing use of telehealth was made possible due to necessary policy changes to accommodate technology-driven appointments during the pandemic. For example, policies on HIPAA changed to allow healthcare providers to administer support through platforms like Zoom, and Medicare policies expanded to allow coverage for telehealth visits [3].

In 2025, most healthcare providers are back to offering in-office visits. However, many continue to offer telehealth services due to the convenience it serves many people, especially those who are unable to take off of work for visits, aren’t located close to their doctor’s office, or have other responsibilities that make them unable to fit in-person visits into their schedules. Unfortunately, it is unknown if Medicare will cover telehealth for all of 2025. Currently, Medicare will cover most telehealth services until March 31, 2025, and after April 1, 2025, you must be located in a rural office or medical facility for most telehealth services to be covered [4]. Future legislation will determine whether Medicare will revert to covering most telehealth services from any location.

Key Telehealth Services Covered by Medicare in 2025

Medicare currently covers the following telehealth services:

Virtual primary care visits [5]
Mental health services [6]
Monthly End-Stage Renal Disease (ESRD) visits for home dialysis [4]
Acute stroke diagnosis, treatment, and evaluation [4]

Telehealth Accessibility and Infrastructure

To ensure that telehealth can be accessed equally by all beneficiaries, a few guidelines must be set in place:

Broadband expansion initiatives for rural beneficiaries: Fast-speed internet access must be available to beneficiaries in rural areas for them to properly access the benefits of telehealth services. Otherwise, those in rural areas may have to travel long distances for their healthcare services [7].
User-friendly platforms for seniors: Telehealth platforms should be designed with individuals with limited technology knowledge and ability in mind. Seniors, who may be less tech-savvy, may struggle with virtual visits if the sites aren’t accessible and easy to navigate.
Integration with existing Medicare systems: Embedding telehealth services into existing Medicare systems ensures a seamless transition for billing, coordinating care, and keeping track of services.

Artificial Intelligence: The Engine Driving Primary Care Innovation

Healthcare providers use a handful of AI platforms to make healthcare more accessible, efficient, and accurate. AI platforms are supporting patients through diagnosis all the way through treatment in many ways. The possibilities with AI are endless, but it is currently being used to help diagnose conditions, develop patient treatment plans, and support clinicians in medical decision-making [8].

For example, AI algorithms have the impressive ability to analyze large sets of medical data and images, assisting clinicians in spotting diseases so they can move on to treating them quicker [9]. Additionally, AI can also be used to predict individual patient health risks by scanning their medical history and information on their current diagnoses, and create an effective treatment plan based on this data [9].

AI-Powered Triage and Risk Assessment

Virtual health assistants for initial patient screening: Having a virtual health assistant is like having access to a medical professional at your fingertips. They can help screen patients through simple questions about health concerns and history to identify potential health issues early or practice preventative care. Screening virtually, whenever possible, saves individuals a trip to the doctor’s office.

Predictive analytics for early disease detection: Predictive analytics examine an individual’s health history and anticipate what health issues may arise in the future [10]. Using data, predictive analytics and machine learning models may detect even the earliest signs of diabetes or heart conditions, which can mitigate more severe and life-altering issues in the future [11].

AI-guided decision support for providers: AI can help organize patient health data and provide evidence-based recommendations for diagnosis and treatments, which help doctors create the best plans for their patients. These platforms work by analyzing medical knowledge combined with individual patient data and universal best practices to optimize care and reduce the chance of errors in diagnosis or treatment [12].

Enhancing Chronic Disease Management with AI

Nowadays, chronic disease management is made simpler through the use of wearable devices, AI-driven medication management, and personalized treatment plans. Everywhere you turn, people are wearing smartwatches to track their step count and heart rate. But, smartwatches and wearable devices can do more than this—they can help detect health issues like high/low blood pressure, heart disease, and even sleep disorders [13].

Other AI-driven technologies, like medication management systems, can help individuals follow their prescriptions by receiving reminders to take their medications at the right time [14]. This can be especially helpful for seniors struggling with memory or cognition issues. AI can also provide personalized lifestyle and treatment tips, helping individuals make informed decisions about their diet, exercise routine, medications, and supplements, ultimately helping them control their health and well-being.

The Synergy of AI and Telehealth in Medicare Services

The shift toward using AI and telehealth in Medicare is quickly evolving this landscape, increasing efficiencies every day. Real-time language translation allows healthcare providers to communicate with all patients, regardless of language barriers [15]. This ensures that all patients have equal access to care and treatment instructions they can easily grasp and understand. AI also assists in documentation and coding to help simplify administrative tasks, like paperwork [16]. This means that healthcare providers can spend less time on organizing files and more time treating their patients.

Navigating the New Primary Care Landscape: A Patient’s Guide

Medicare offers a bunch of telehealth services, making it easier than ever for patients to access care from the comfort of their homes. Telehealth services include virtual visits with primary care providers, mental health services, and some qualifying specialist consultations. Coverage may depend on location, type of service, and the Medicare enrollment of the provider, so it is important to check coverage with your provider.

Once you confirm coverage, prepare for your telehealth primary care visit by checking that your internet connection is stable, that your device’s camera and microphone work, and that you are situated in a private, comfortable space. Before your appointment time, make a list of questions or topics you’d like to discuss with your provider.

Challenges and Considerations in the AI-Telehealth Era

It’s completely normal to have some concerns about AI, especially if you are new to it. For one, it is crucial for healthcare providers to initiate cybersecurity measures to protect patient information at all costs and to comply with HIPAA regulations. Patients should be educated on how AI will use and protect their data.

It’s also important to acknowledge that not everyone has access to the technology essential to participating in telehealth visits or AI-based care. If you don’t have high-speed internet, wearable devices, or a smartphone, you may be at a disadvantage. Healthcare systems must mitigate this gap by investing in programs that fight for equity in access to care for all and efforts to support those with limited tech literacy.

The Impact on Healthcare Providers

A learning curve comes with any major advancement in the healthcare field, including the use of AI. This means that healthcare providers will need to devote some time to AI-based care training and accumulating new skills. They must get used to using AI technology daily, as it is being used to increase efficiency on many tedious tasks. This means that instead of taking time out of each day for scheduling, intake forms, and documentation, they can pass these tasks onto AI and use their time elsewhere, like personalized care.

Medicare Policy Updates Supporting AI and Telehealth Integration

In 2025, to align with the rise of AI-driven technology in the digital world, Medicare updated policies so that they include more support for telehealth and AI-based healthcare services. Some of these updates include coverage for virtual visits [6], AI-assisted care [17], and accessible and high-quality remote healthcare. Medicare aims to assess the quality of virtual healthcare services by evaluating the use of AI in remote care settings to ensure that patients are receiving the same, high-quality care—whether they are in the office or at home [18].

Preparing for Your 2025 Medicare Enrollment: Telehealth Considerations

We understand that updates to Medicare AI-based care and telehealth in 2025 are plentiful and a bit overwhelming. Here are answers to some frequently asked questions you may still have about the process that you can consider before enrollment:

Does Medicare cover telehealth services in 2025?

Yes, Medicare will still cover telehealth services in 2025. This includes physician visits, mental health services, and certain clinics [6]. Please be sure to check with your provider about the specific services they offer through telehealth.

How can I stay informed about Medicare’s telehealth options?

Because there are frequent updates to Medicare coverage over the years, it is important to stay updated on the most recent policies. In 2025, some telehealth options may have different reimbursement policies, and the types of care may differ from prior years. By keeping tabs on Medicare’s official website and the Centers for Medicare and Medicaid Services (CMS) website, you can stay informed and get the latest updates on telehealth policies.

Conclusion: Embracing the Digital Transformation of Primary Care

With all the changes and advancements in the technology field affecting healthcare, it’s normal to feel overwhelmed and a bit confused. Hopefully, this blog cleared up some confusion on emerging technology, like AI and telehealth, and its relationship with Medicare and healthcare in general. The technological world is constantly evolving, and with these changes come improvements to efficiencies, access, and research—all benefiting your wellness. Get involved in these advancements and don’t be afraid to ask questions to stay informed about your healthcare journey!

Resources:

What the 2025 Medicare Part D $2,000 Cap Means for Beneficiaries

Did you know that Medicare will undergo major changes in 2025? If this news comes as a surprise, we are here to help ease any anxiety by outlining the changes and explaining what they mean for your coverage. Medicare Part D is a voluntary section of Medicare that provides financial assistance and coverage for many prescription medications. Although enrolling in Medicare Part D is completely optional, it may be recommended for seniors who are taking multiple prescription medications for chronic conditions and need financial assistance. Keep reading to learn about the changes coming to Medicare Part D in 2025, including a new out-of-pocket cap, updated payment plans, and changes to Medicare responsibilities.

The $2,000 Out-of-Pocket Cap: A Game-Changer for Beneficiaries

The Inflation Reduction Act was designed to reduce the high and burdening costs of prescription medications for millions of people on Medicare [1]. Due to the Inflation Reduction Act, Medicare Part D implemented a new out-of-pocket cap of $2,000 per year [2]. This means that once beneficiaries reach this cap, they will no longer have to pay for prescription medications out of pocket.

This is a huge positive change compared to the out-of-pocket cap for Medicare Part D just last year. In 2024, the cap on total out-of-pocket costs for prescription drugs for those taking generic and brand-name was $8,000—which means that most individuals were contributing about $3,300 toward brand-name drugs and $3,400-$3,800 in generic drugs [3].

The new 2025 out-of-pocket cap benefits many different types of beneficiaries. First, it benefits those who have multiple chronic conditions or take expensive medications, like cancer treatments, by reducing their financial burden [4]. Second, it aids those who make low-to-moderate incomes and/or seniors on fixed incomes who may have struggled to reach the point of financial relief due to the previously high cap.

Breaking Down the 2025 Medicare Part D Structure

The Three Phases of Coverage

In 2025, Medicare will simplify its coverage into three basic phases [5]:

Annual Deductible: In this phase, beneficiaries pay for their prescription drug costs until they reach their deductible. Once they hit the deductible, they move to the next phase, in which plan sponsors will cover the remaining costs of medications.
Initial Coverage: In this phase, beneficiaries will continue to pay fixed copayments while Medicare and insurance plan sponsors cover the rest of the costs. This makes things much more affordable for beneficiaries, who often got caught in the “donut hole” of high costs in the past. Once beneficiaries reach the $2,000 cap, they move onto the next phase.
Catastrophic Coverage: In this phase, beneficiaries only need to pay small copayments the rest of the year, while Medicare covers the rest of the costs.

Cost-Sharing Between Stakeholders

Costs are shared among beneficiaries, plan sponsors, and Medicare in different ways depending on the phase.

In the Annual Deductible phase, beneficiaries pay a deductible of $590 at most [6]. Plan sponsors and Medicare do not start contributing during this phase since the deductible has not yet been reached [5].

In the Initial Coverage stage, the beneficiary has met their deductible and will now contribute through copayments and coinsurance for their prescription medications. Plan sponsors pay a large portion of the cost, while Medicare does not contribute. Once the beneficiary reaches the $2,000 cap, they move into the final phase [5].

In the final phase, Catastrophic Coverage, beneficiaries pay small copayments for the rest of the year. Medicare takes care of most costs at this stage, while plan sponsors cover whatever is not covered by Medicare and copayments [5].

Beyond the Cap: Other Significant Changes to Medicare Part D

Wondering about the Medicare “donut hole” everyone is talking about? This is understandable. The donut hole is a metaphor used to describe the gap in Medicare Part D coverage where beneficiaries had to pay a large portion of prescription medication costs after reaching their spending limit but before they qualified for catastrophic coverage. Thankfully, the Medicare Part D coverage eliminates the donut hole, putting you in the Catastrophic coverage phase as soon as your costs reach the $2,000 cap [7].

This leads to the introduction of the Medicare Prescription Payment Plan, or MP3, which spreads out the out-of-pocket costs by implementing a monthly payment plan. Anyone who opts for Medicare Part D can use M3P and avoid paying all at once [8].

Impact on Medicare Advantage Plans in 2025

You may be wondering how all of these changes may affect Medicare Advantage plans in 2025. Most Medicare Advantage plans include Part D prescription drug coverage [9]. This means that the changes to Part D apply to beneficiaries on a Medicare Advantage plan that includes Part D. If you are torn about whether to choose a Medicare Advantage plan or go with Original Medicare, it is a good idea to research each option thoroughly based on your needs. Medicare Advantage plans tend to be beneficial for those who are looking for more comprehensive benefits, while Original Medicare tends to be more beneficial for those who want more freedom to choose any doctors who take Medicare (including those outside of the specific plan network [10]. However, there is not a one-size-fits-all answer to whether you should choose Medicare Advantage or Original Medicare—it depends on your specific needs and preferences.

Medicare Part B in 2025: Related Changes and Considerations

The 2025 Medicare Part B premium cost for physician visits and outpatient care increased slightly since last year and is set at $185 per month [11]. The increase to Part B is separate from the change to the out-of-pocket cap in Part D.

Navigating Your Medicare Choices in Light of 2025 Changes

To holistically and conveniently reassess your 2025 Medicare coverage in light of these changes, follow these steps:

Review your current plan. Look at your current coverage and how well it meets your healthcare needs. You can use the Medicare Plan Finder to compare your current plans with any other plans you may be considering. Complete this step between October 15 and December 7, 2025, as this is the Medicare Open Enrollment Period when you can make coverage changes [12].
Make changes to your coverage by December 7, 2025—the end of the open enrollment period. If you wish to switch from one plan to another, you must do so by this date.

Financial Planning for the 2025 Medicare Landscape

To budget for out-of-pocket costs according to the 2025 Medicare updates, it is important that you review your prescription drug costs. Make a list of your current medications and check their costs under your plan so you are aware of when you will reach the $2,000 cap. This will help you budget your spending before you reach the cap. You should also consider Medicare Advantage plans if you need more than just prescription drug coverage, and these plans often bundle additional benefits with prescription drug coverage, like dental, vision, and wellness services [13].

Frequently Asked Questions About 2025 Medicare Part D Changes

Common Concerns and Misconceptions

Question: Will the new $2,000 cap mean that I’ll never have to pay for prescription medications again?

Answer: No. After you reach the $2,000 cap, your out-of-pocket spending for covered prescription medications will be covered, but you will still have to pay small copayments for the rest of the year. If you take medications that are not covered under Medicare Part D or Medicare Advantage, you may still need to pay for those fully.

Impact on Specific Medications and Treatments

Question: How will the changes to Medicare Part D affect the cost of my medications?

Answer: This depends on which Part D plan you choose. The new $2,000 cap will help reduce your out-of-pocket spending for covered prescription medications, but it is important to check if all the medications you need are covered. Some medications may become more affordable due to this change, but some may not.

Conclusion: Embracing the Future of Medicare Part D

With this overview, you should now feel ready to navigate the changes made to Medicare Part D in 2025. Remember to plan for the future proactively and mark the annual enrollment period on your calendar in case you wish to make changes to your plan. Stay informed, and don’t be afraid to ask questions!

Sources

Medicare Plan Finder: https://www.medicare.gov/plan-compare/#/?year=2025&lang=en

Complete Guide to Medicare Coverage for Ozempic and Diabetes Supplies

If you’ve been prescribed Ozempic to treat your diabetes, you likely know that prices can be costly. Government-funded programs like Medicare help cover the costs of many prescription medications, but whether it covers Ozempic is a bit tricky. This blog post will cover an overview of Ozempic and its Medicare coverage explanation, as well as some other diabetes treatment tools that Medicare helps cover.

Overview of Ozempic

What is Ozempic?

Ozempic (semaglutide) is an FDA-approved injectable prescription medication for the improvement of blood sugar levels of adults with type 2 diabetes [1]. Its active ingredient, semaglutide, helps the body respond to rises in blood sugar and makes the pancreas produce more insulin at these times. Simultaneously, it prevents your liver from releasing too much sugar [2]. Although this drug is FDA-approved and has helped many individuals with their type 2 diabetes, it also has several limitations. Serious side effects and allergic reactions may occur, so you must first consult with your healthcare provider to determine if Ozempic is right for you.

Ozempic and Pre-Diabetes

As previously mentioned, Ozempic is approved for type 2 diabetes. However, there is an “off-label” use of Ozempic for prediabetes, or elevated blood sugar levels that haven’t yet met the threshold of type 2 diabetes [3]. “Off-label” refers to a medication being prescribed for a condition the FDA has not formally approved it for [4]. Although it is typically not recommended to prescribe a drug to treat a condition other than what it is formally approved for, some physicians have prescribed Ozempic for prediabetes. This is because of current research that has found that other glucagon-like peptide-1 (GLP-1) medications helped people with prediabetes lower their blood sugar levels enough to prevent type 2 diabetes [5].

Despite this research, the FDA raises concerns about prescribing “off-label” GLP-1 medications for prediabetes. This is because using drugs unapproved for specific uses means that these drugs have not been carefully reviewed for efficacy and safety, which can lead to significant risks [6].

Medicare Coverage for Ozempic

Medicare Part D Coverage

Medicare Part D plans cover the costs of many prescription medications, and for 94% of plans, Ozempic is included. However, the amount of coverage you receive depends on which coverage stage you are in. If you are still in the deductible stage, meaning you haven’t yet met your deductible minimum payment, Ozempic will likely cost more than if you are in the post-deductible stage [7]. Additionally, Ozempic is often classified as a Tier 3 or Tier 4 medication, which means that it is a brand-name drug and often has a higher copayment than Tier 1 and 2 drugs [8]. Tier classification and copayment will vary based on a plan’s specific formulary.

Coverage Restrictions

It is important to note that Medicare coverage of Ozempic comes with a few restrictions. First, at this point, Medicare covers Ozempic for its FDA-approved purpose only: the management of type 2 diabetes. Medicare is not permitted by law to cover drugs for weight loss [9], though this may change in the future depending on policy changes. Additionally, Medicare requires most drugs to have prior authorization, meaning that your prescriber must contact your insurance plan and confirm that the prescription is necessary before you can receive coverage [10].

Medicare Diabetic Testing Guidelines

Comprehensive Diabetes Monitoring

Blood sugar monitoring is crucial for the management of diabetes. If you were advised to take insulin for your diabetes, your doctor will likely also recommend a continuous glucose monitor or CGM. This device gives you real-time updates about your blood sugar levels [11]. You should typically test and record your blood sugar levels at multiple times of the day—before meals and before you go to sleep [12]. You may need to test your levels extra when you are sick or have changes in your diet or exercise routine. Medicare Part B covers certain diagnostic procedures for type 2 diabetes. If your doctor deems you “at risk” for diabetes and recommends that you get a blood glucose laboratory screening test, your Medicare plan can help cover these tests based on your plan’s Part B coverage limits. It is important that you listen to your doctor’s recommendations for screening tests—these can help prevent diabetes before it’s formally diagnosed, and keep you up to date on your current health needs.

Preventive Measures [14]

Medicare cares about preventing diabetes in every way possible. This is why they put forth the Medicare Diabetes Prevention Program (MDPP), which is a health behavior change program designed to help you make the lifestyle changes necessary to reduce your chances of developing diabetes. In this program, you’ll learn how to make life-altering changes to your diet and exercise patterns, tips for controlling your weight, a designated coach to help you through these changes, and a group of people who are going through something similar who you can turn to for support. The program begins with 16-week sessions on these topics and also includes 6-month follow-up sessions to track your progress. According to the Centers for Disease Control and Prevention (CDC), these programs can help reduce your risk of developing type 2 diabetes by over 70% [15].

Diabetic Supplies Covered by Medicare Part B

Comprehensive Supply Coverage [16]

Medicare Part B covers blood glucose self-testing equipment (such as a CGM), insulin pumps as well as the insulin itself, and therapeutic shoes and shoe inserts. If you use insulin, Medicare will cover up to 300 test strips and 300 lancets every 3 months, and 1 lancet device every 6 months. If you do not use insulin, Medicare will cover up to 100 test strips and 100 lancets every 3 months, as well as 1 lancet device every 6 months. Blood glucose self-testing equipment will only be covered after the patient receives a prescription from their doctor claiming this is necessary. These supplies will not automatically be sent to the patient—the patient must first request them. It’s important to note that beneficiaries may have additional coverage and programs based on their specific plan.

Continuous Glucose Monitoring (CGM) Coverage

Medicare CGM Guidelines [17]

Many people with diabetes must regularly monitor their blood sugar levels with a CGM, or continuous glucose monitoring, device. The cost of this device can get pricey, which is why many benefit from Medicare coverage of CGM devices. Medicare helps cover the cost of CGM devices under a few conditions:

You must be diagnosed with diabetes mellitus.
You must take insulin or have a history of issues with low blood sugar
You must receive a prescription for diabetes testing supplies and guidelines on how often you should test your blood sugar levels
You must be trained on how to use a CGM device. If you have a caregiver, your caregiver must be trained on how to use this device.
You must make regular appointments to visit your doctor in person or have Medicare-approved telehealth visits.

Additionally, not all CGM devices are approved to be covered by Medicare. The particular type of CGM device must be approved by your plan and the FDA to be covered [18].

Impact on Patient Care

Doctors often recommend continuous monitoring devices for diabetes for a reason—they help keep patients in the know regarding their blood sugar levels. These real-time updates can help patients make smart decisions about their diet, exercise patterns, and medications. Using a CGM device in combination with Ozempic treatment can help patients understand if their treatment is working properly, and if it may be causing any complications or side effects [19]. Above all, they keep patients in the know and aware of what is happening in their bodies, empowering them to take the front seat in managing their health.

Finding Medicare Suppliers for Diabetic Supplies

Navigating Supplier Networks [20]

If you prefer to order your medical equipment directly from a supplier instead of from the pharmacy, this can be done as long as the supplier is Medicare-approved or in your plans network. You’ll need a prescription from your doctor to order these supplies. To discover which medical equipment providers are approved by Medicare, visit the Supplier Directory, or your specific plan’s provider directory

Insurance Considerations

Diabetes medication and management tools may differ in coverage depending on your type of insurance. Research your specific plan to learn more about diabetes coverage.

Financial Considerations

Out-of-Pocket Costs

Medicare caps the monthly cost of insulin at $35 for those who qualify for Medicare coverage of diabetes management tools and medications [22]. This means that you will never pay more than $35 per month for covered and approved insulin, and you will not have to pay a deductible if your insulin is covered under the Medicare program.

Savings Opportunities

If you are looking to save money on diabetes management tools and medication, there are options out there for you. Unfortunately, Medicare cannot use manufacturer coupons to reduce the cost of diabetes medications [24], but there are other ways to save money. There are several state based and federal programs which help Medicare beneficiaries with prescription savings. Patients should research patient assistance programs to see if they qualify. These programs can end up saving patients a great deal of money on monthly prescription costs. Additionally, if you receive a 90-day supply of treatment, you’ll only pay $35 per month, meaning that your out-of-pocket maximum will be at most $105.

Potential Challenges and Solutions

Coverage Limitations

Coverage limitations and plan formularies may create roadblocks in your treatment journey. For an unlisted drug to be covered by Medicare, your doctor may need to provide a strong rationale for why this off-label drug is necessary, as opposed to other FDA-approved drugs, for it to be potentially covered. Navigating insurance complexities can feel confusing and isolating, which is why you shouldreach out to professionals for help in this space.

Alternative Approaches

Managing your diabetes using the interventions recommended by your doctor is highly recommended to ensure your health is maintained. However, there are ways to manage your diabetes without medication or supplies. Lifestyle interventions, like eating a healthier and more nutritious diet, exercising regularly, and getting enough quality sleep can help manage your diabetes [24]. It is important to still consult with your healthcare provider regularly while adjusting your lifestyle so you can check if these lifestyle changes are making a positive impact on your health.

Conclusion

As long as Ozempic has been prescribed by your doctor for the treatment of type 2 diabetes, Medicare currently covers the cost for the majority of plans. It is crucial that you closely follow your doctor’s instructions for taking care of your diabetes—everyone’s treatment journey is different. With ongoing research in diabetes management, we may see more evidence emerge about the effectiveness of certain medications. Contact Greater Good Health today with any questions about diabetes management, Medicare coverage, and alternative treatment options.

How to Switch Primary Care Doctors: A Comprehensive Guide

As a senior, the relationship you have with your primary care physician should be one of the most important relationships in your life. Not only is your primary care doctor responsible for monitoring your health and prescribing necessary medications, but they also act as part of your health support system and a resource for all your health needs. So, what if you feel you aren’t getting the best out of your primary care doctor, or your doctor just isn’t fitting your preferences and needs? Many patients consider changing doctors for these very reasons. Just because you already have a primary care physician that you visit regularly, doesn’t mean they are the right fit. This is why you must know the signs that indicate you should consider changing your primary care doctor, as well as how to navigate this process. Keep reading to learn more!

Reasons for Switching Primary Care Doctors

Personal Care Dissatisfaction

Although you may be getting your prescriptions and completing your annual checkups, you may still feel like your health needs aren’t being heard. If you feel this way, you are not alone. According to a research survey, 71% of patient participants reported that they felt their doctor lacked compassion when communicating with them. Likewise, 73% reported that they felt rushed by their doctor during their appointments [1]. There has also been a decline in comprehensive care, meaning that doctors often opt to meet immediate health concerns more than focusing on preventative care and holistic issues [2]. These issues can have a drastic negative impact on your healthcare experience as a patient and leave you feeling discouraged.

Practical Considerations

On the other hand, your doctor may communicate well with you, but not meet your practical needs. For example, your primary care doctor of choice could be out of your insurance network, making the costs of appointments out of your budget. Or, perhaps you recently moved, and now the location of your primary care doctor’s office is too far to visit conveniently. There may be other practical issues, like limited office hours times you are available for appointments, or a lack of specializations in your area of need. Although it likely feels frustrating that you found a doctor that fits your personal care needs but not your practical needs, this is a viable reason for switching primary care doctors.

Red Flags in Current Medical Care

If you experience any of the following “red flags” in medical care, you should strongly consider switching primary care doctors. These red flags can have detrimental impacts on your health and well-being.

Misdiagnosis concerns: If you are concerned that your doctor has misdiagnosed you with a condition you don’t have, or that doesn’t make sense for your symptoms, consider seeing a different doctor for clarity.
Lack of follow-up: If your doctor is consistently late with follow-up calls or appointments, or lacks them altogether, this is a sure sign that it is time to find a new doctor who values your time and health needs.
Outdated treatment approaches: If your doctor is recommending treatment that is outdated or not backed up by any research, this should cause alarm.
Unprofessional conduct: If your doctor speaks to you or acts in a way that is insensitive or disrespectful, find a new doctor immediately.

Is It Okay to Switch Primary Care Physicians?

Ethical and Medical Perspectives

As a patient, you have the right to switch primary care physicians whenever you see fit [3]. Your primary healthcare provider should fit the professional medical standards and laws, so if they are not meeting requirements, it’s time to find a doctor who will. Your level of comfort and trust as a patient is key, and many doctors out there will meet professional medical standards, your practical considerations, and your communication needs. It’s just a matter of making the extra effort to switch.

Potential Concerns and Misconceptions

There may be some concerns that are holding you back from changing doctors. For example, many believe that changing doctors is difficult and requires starting your healthcare journey completely from scratch. However, these are common myths about changing doctors. Although switching primary care physicians can take some time and research, it shouldn’t be extremely difficult. And, your medical records should be transferred from your old doctor to your new doctor so that your new doctor will have context about your medical history before your first appointment [4].

Steps to Switch Primary Care Doctors

Initial Research and Preparation

The first step for switching primary care doctors is preparing by researching what doctors are out there that can fit your medical needs. If you have medical insurance, visit your insurance portal and search “primary care physician” under the “find a new doctor” page. This will bring you to a list of primary care physicians who are under your insurance. You can narrow down the search by applying filters, like location, specialization, spoken language, and/or credentials.

After you narrow down your search, it is important to check that your physicians have reputable credentials and specialize in your area of need. Make sure they are in a location you are comfortable getting to and from, and that they are currently accepting new patients. Read reviews carefully to see if other patients had a positive experience seeing them. After you confirm that this is a doctor you would like to potentially switch to, call their office to verify that they take your insurance before making an appointment for a consultation.

Consultation and Evaluation

An initial consultation appointment can help you understand if this new primary care physician is a good fit for your needs and preferred style of care. To prepare for the appointment, create a list of your current medication conditions, medications, and concerns. It is also smart to note family histories of conditions, regardless of if you have this condition diagnosed or not. Include some questions to ask your new doctor, even if these questions aren’t about your medical conditions. For example, you could ask them about their approach to holistic healthcare or their communication style as a doctor.

Medical Records Transfer Process

In most cases, you can access your medical information through your online patient portal. If you don’t have a patient portal or can’t find the information you are looking for on it, give your primary care doctor’s office a call and ask about the process for requesting medical records to be transferred to a new doctor. You will likely have to fill out a few consent forms to have this information released to your new doctor [4]. After your form is processed, your medical records should be transferred safely from your old doctor to your new doctor. To check that this transfer was completed properly, confirm with your new doctor if they received your medical records and if anything is missing.

Choosing the Right Primary Care Physician

Qualification Considerations

If you are unsure about what qualifications to look for when choosing a new primary care physician, there are a few standards you should pay attention to. First, take a look at their board certifications. A board certification is an achievement that notes that a physician has shown advanced knowledge and skills in their area of specialization [5]. To verify if your new doctor is certified, visit the American Board of Medical Specialties Certification Verifier tool.

Next, research how many years of experience they have. Although it isn’t always the case, many years of experience usually indicate that this doctor is a master in their practice and has had plenty of experience working with patients just like you. Then, explore their specializations and make sure they match your needs. Finally, see if the doctor has any hospital affiliations. If a doctor has a hospital affiliation, it means that they partner with that hospital and are able to easily refer you to that hospital for specific procedures, many times even performing these procedures themselves at the hospital [6].

Practical Factors

You’ll also want to pay attention to a few practical factors of your potential primary care physician. First, look at the location of the new office and determine if it is possible to get to and from. Next, inquire about the communication style of the new doctor. You can do this by reading reviews and recommendations from other patients. These reviews will likely include current patients’ sentiments toward the doctor, how the doctor communicates, and their overall quality of care.

Navigating the Transition

Managing Ongoing Medical Care

Once you transition from your old doctor to your new doctor, there are a few things you’ll want to keep on your radar. First, make sure to stay consistent with your current prescriptions, unless they are causing any concern. Just because you switch doctors does not mean you switch medications! If you have any concerns about medications prescribed by a former doctor, ask your new doctor about the prescriptions and voice your concerns. You should also discuss your current treatment plan with your new doctor. But until your first appointment, maintain this treatment plan. Finally, you should ask your old doctor and your new doctor about how they coordinate care for patients who are switching.

Potential Challenges

If you had to leave your old provider suddenly and couldn’t find a new provider for a while, you may experience some potential challenges. There may have been a gap in medical coverage, meaning that you lacked medical care during the time between leaving your old provider and starting care with a new one. This gap may also occur if you had to switch doctors due to a change in your medical insurance, which means that certain co-payments and services might no longer be covered [7].

Another challenge you may face is adjusting to a new medical approach. Your new doctor may have a different style of care than your old one, which can take some time to get used to. Always voice your concerns if you have any, but be patient with yourself and your doctor during this transitional period!

Legal and Insurance Considerations

Insurance Provider Guidelines

If you switched insurances and needed to find a new doctor, just because that new doctor is part of your new network doesn’t mean that the same services will be covered. There are network-specific restrictions that may affect what is covered and not covered, which could determine price differences. Another consideration to be aware of is referral requirements, which is a written referral from your old doctor to your new doctor or specialist. A referral is necessary to make certain specialist appointments [8].

Patient Rights

When switching to a new doctor, you will get a patient informed consent form to fill out. It is important that you read and understand this document thoroughly. This document will explain your rights as a patient to be involved in your medical decision-making [9]. In addition to the information on the consent form, you should also know that the healthcare provider technically owns the physical record of your medical history—but you generally have the right to access this information at any time [10].

Potential Impacts on Medical Care

Continuity of Treatment

Although switching primary care physicians has an adjustment period, it is important that you stay on top of managing your chronic condition and maintaining treatment momentum. Stay diligent in taking care of your health and communicate your medical history to your new doctor.

Psychological Aspects

It is vital to build trust with your new physician, as this is someone who will be partly responsible for your health over the years. It can feel scary to trust someone new with something as personal as medical information, but you must overcome this anxiety to get the best possible healthcare. Transparency is key when creating a positive and helpful relationship with your new doctor—if you are not telling them the whole truth about your health or concerns, you won’t get the most out of primary care.

Red Flags and When to Reconsider

Signs You’ve Made the Right Choice

When you encounter positives about your new primary care doctor, make note of them! This will help solidify that you’ve made the right decision. If you’ve found that communication between you and your doctor is honest and helpful, this is a sign you’ve made the right choice. Other signs include receiving comprehensive and holistic care, as well as a better understanding of your health needs and conditions.

Warning Signs of Potential Issues

Sometimes, even the primary care doctor we switch to ends up not being the right fit. Some signs that it may be time to reconsider your primary care provider include experiencing persistent communication issues, finding that your doctor lacks professionalism, or discovering that your doctor has healthcare philosophies that do not positively impact your health.

Conclusion

Empowering Patient Healthcare Choices

The future of your treatment is in your hands. Taking the step to switch from a primary care physician who does not meet your needs to one who is a helpful asset in your journey is often the first step of proactive healthcare management. Contact Greater Good Health today to share your experience and learn more about finding a new primary care physician!