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For those of you who full time and aren't stationary, where do you have your primary care doctor?

Thanks - Rick and Dru

Full Time 3-1/2 months and counting!

 

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We are back to the Houston area where we had lived.  We see all the Doctors and relatives and our stationary friends in November and December.  After that hit the road.

When on the road, and need basic medical care while on the road, we look for an urgent care facility in the area.  I look on line at the ratings for near by places and pick one.  We are on Medicare and a Supplement G plan so we only need a place that takes Medicare.

Ken

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We wintered in or around the same area and that's where we established our primary care.  We didn't have to stay in the same place but we stayed in the same state where we could easily get to him, if needed.  It works just fine if you're not being monitored for something serious although we have known travelers on dialysis who seem to manage.  Occasionally we needed an urgent care for simple things as we traveled different states and once we had excellent care in Jasper Alberta Canada for a gallbladder attack.  We did have to pay directly - no insurance but it was extremely reasonable.  She even called as we were traveled across Canada to see how I was.

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When we went on the road I expected to find someplace with less winter than Minnesota in which to eventually settle. We decided to keep our previous primary doctors until that time rather than change multiple times. After 3 years, during which time we visited all 48 contiguous states, Dave declared he only wanted to live in Minnesota. So, we are back here with me staying inside all winter as my way of coping with the cold and ice and I'm once again seeing the same doctor. Dave's doctor retired during those years of travel so he has a new one now. I don't recommend doing what we did, though, as changing doctors to our domicile location while traveling would have been a safer thing to do in case we were ever challenged. More states are issuing more challenges as the years go by.

Linda Sand

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Before I went full time I was in perfect health and almost never saw a Dr. so I never had a primary care Dr. Now I have Medicare and I just go on the Medicare website and find a Dr. where I happen to be. I roll about every 3 months or less so in the past year I have seen 4 different Drs. The first one found out that I have diabetes so the other 3 were for follow ups. Its a new year now and everything is under control, so I will probable just get an annual physical and go with it. Doing the same thing with the DDS, and always get the new patient discount.

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I have a PCP thru Kelsey Advantage Plan, Medicare. I don't have a supplement policy for BH or myself. This saves $600 per month. I had a bad year during 2019, skin cancer on chest, surgery in throat from outside after three attempts going down the throat didn't work and a new pacemaker. My cost for the three issues, $200, $300 and $200 or $700 total. PCP visit doesn't have a copay and specialist $35. I see a specialist two or less times per year. Kelsey is the only 5 star advantage plan in Texas but they only take patience from the few counties in and around Houston. I don't pay extra for the Advantage plan and it, like most Advantage plans, includes things like drug plan, membership in YMCA, eye doctor visit once per year and transportation to and from doctor's office if needed and a few others. Total out of pocket for the year $3,000. I have never had better health care or cheaper meds, if thru Kelsey, $7.50 for 90 day supply.

The down side is that you only get emergency care if you are out of the coverage area. Many who travel most of the time don't like that. I spend 4 months during the summer in the UP of MI and last year my neighbor had a heart attack there and they took him to a hospital about 35 miles away, he has an Advantage Plan from South Florida with emergency care only if out of area and they keep him over night and then sent him down state because they said that they couldn't do any more for him? They keep him for two days down state and then released him. He had bypass surgery in South Florida during the winter. He told me that he was pleased with the health care he received when out of his Advantage plan area.

I am interested in what others think regarding this issue and what else I could be missing? I have done this for more then three years. $600 dollars per month for the two of us would be $7,200 per year thru United Healthcare AARP.  Even if both of us maxed out the out of pocket for the year it would only be $6,000.

 

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On 1/17/2020 at 5:08 AM, Twotoes said:

The first one found out that I have diabetes so the other 3 were for follow ups. Its a new year now and everything is under control, so I will probable just get an annual physical and go with it.

Please share with me how you find doctors who will prescribe medications based upon the previous doctor's tests and diagnosis. I have some experience in that area and the only time that was the case was when we had a reason to stay with our son and his doctor gave Pam a 2 month prescription for meds to get us back to TX, after speaking with her doctor by phone. Most will not do so because of malpractice insurance issues. 

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I used this a couple of summers ago and since then have met a few people who "full-time" nine months and stay in one place for the remaining three months.  I don't know if this will work for you but it has worked for the couples we met.  All of them wintered/summered for their three months in one place and had a PCP who they met but would also do Tele-Med appointments with them via the computer when they traveled.  If labs were required they either went to a Quest Lab or other independent lab to have the labs drawn and results faxed to their PCP.  We aren't in a big city and one of my doctors only visits 2 days a week and goes to another city for 3 days.  Should I need to see him on the days he's not in my area I could go to the office (manned by nurses for this purpose) and do a Tele-Med visit with him but on his schedule.  It can sometimes be a longer wait but it's the best option.  Thankfully, that practice has now found a full-time doctor to man the office five days a week.  Only one of the three couples had additional hoops to jump through because of their insurance.  I didn't pry when an explanation wasn't provided but you should clear this with your insurance to make sure they'll cover this.

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8 hours ago, Kirk W said:

Please share with me how you find doctors who will prescribe medications based upon the previous doctor's tests and diagnosis. I have some experience in that area and the only time that was the case was when we had a reason to stay with our son and his doctor gave Pam a 2 month prescription for meds to get us back to TX, after speaking with her doctor by phone. Most will not do so because of malpractice insurance issues. 

There are doctors all over America who will prescribe a wide variety of medications with just a short conversation and no testing at all.  Have you been following any of the stories related to the opioid crisis?  

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Yes, if you want to go to a hack.  Don't you care about yourself?  Any physician who wouldn't even do a simple blood test, etc., would be suspect.  

I had a cough I couldn't get rid of.  Went to a community clinic, physician assistant took history, listens to my breathing, ordered a CBC and a swab for strep before determining whether or not an Rx was in order.  Also saw the physician who directed the clinic who explained that the results were negative for a bacterial infection, asked whether I wanted a cough expectorant with codeine so I could sleep, I declined, so he told me which expectorant/cough suppressant would probably work best, gave me a copy of my results so if it didn't clear within about 10 days,  I could seek additional care.   

 

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I'm not talking about how I handle my own healthcare. But to think that all doctors handle everything exactly the same way is naive. And for what it's worth, the last two times I needed healthcare on  short notice my PCP was booked and I was shunted to two different doctors in the same "practice".  Frankly the sanctity of seeing the same doctor for "continuity of care" is a bit overblown in my mind. 

Thank you for the detailed description of your doctors visit for your cough.  I'm sure that every physician would have handled things exactly the same way. Right?

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31 minutes ago, mptjelgin said:

I'm not talking about how I handle my own healthcare. But to think that all doctors handle everything exactly the same way is naive.

Are you telling me that you know of doctors who will accept another doctor's diagnosis of a continuing medical issue such as diabetes or some other problem that requires continuing treatment and just continue to treat a patient in the manor of the previous doctor with no testing of his own? In our 12 years on the road we used the local emergency medical services for issues similar to those of Barb, but for issues requiring maintenance medications such as high blood pressure, prostate enlargement, diabetes, acid reflux and similar ongoing medical issues we went back to our primary care physician because no doctors could be found to just accept our primary care doctor's diagnosis, partly because they often choose to treat differently and then only after their own testing and diagnosis. 

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My Advantage Plan provides meds in 90 day supply for $7.50, I have five and they are refillable four times or for one year. They will mail to a Texas address only so I have them sent to one of my four Texas children and they send them to me in the UP of MI or elsewhere.

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Kirk-

Have you followed any of the national stories/prosecutions regarding doctors running pill mills and prescribing huge amounts of medications without so much as an office visit?  Online "doctors" who will write/fill prescriptions based on a questionnaire? Of course there are doctors who will prescribe medications without doing their own due diligence/testing.  I'm not endorsing it but I am aware of it. 

Your statement that most will not do so because of malpractice insurance is correct, but that is not an absolute. 

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17 minutes ago, mptjelgin said:

Your statement that most will not do so because of malpractice insurance is correct, but that is not an absolute. 

I suppose it just depends on the sort of care you want. 

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You bet. What care of care you want. What kind of care is available in your area. What kind of care you can afford. Etc.  Life is complex. 

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I thought long and hard about this.....finally came up with.

Spring is fishing season, don't want to miss that.

Summer is travel season. Can't miss that.

Fall is hunting season......can't miss that.

That leaves November, December, January and Feb.  Most times I want to be in Arizona during those days.

So....ALL the medical appointments are for November at the home base.  Anything found amiss and I get to spend time in the snow and clouds doing medical appointments.  That's fine....last year I ended up with medical tests and could not leave until the end of January.  

Pick a time.....when you don't want to be somewhere else and schedule all your appointments at that time.  Leave room in the following months so the follow up tests don't infringe on your PRIMARY time.

I found some decent Doctors....don't want to go through the routine of finding new doctors.

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9 minutes ago, Vladimir said:

Pick a time.....when you don't want to be somewhere else and schedule all your appointments at that time.  Leave room in the following months so the follow up tests don't infringe on your PRIMARY time.

For us, this is the biggest issue.  We travel extensively and are often in our "home area" for only a few weeks a year. With our current system requiring a PCP and a referral to anyone else, the time it takes to run those traps often exceeds the time we have planned to be in the area. 

Some of the folks commenting on this thread are essentially off the road or in a fixed location for months at a time,  not to mention being on Medicare, which makes a difference in how you pursue medical care. 

Edited by mptjelgin

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We are on Medicare and our plan doesn't require a referral but many specialists won't see you without a referral. Even with a referral it takes time to get an appointment.  We are not fulltime but we have had to stay at home or in other areas due to the wait.  Then if you need to address a problem we have had to stay for an extended time to deal with it.  

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If you pick a good area for you annual doctor visits you don't have to hang around waiting for followup appointments. Dermatology tends to have a 30 day lead time at our clinic. When my doctor prescribes a new medicine she like to see me again after I take it for 30 days. One time between visits we went up to the Mississippi River headwaters and followed the Great River Road back down to Mpls for the next visit. Another time we headed down to Iowa to the Winnebago factory for some maintenance issues then back to Minnesota for the followup appointment. Nothing says you have to stay parked when visits are spaced out over time.

Linda Sand

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11 hours ago, mptjelgin said:

With our current system requiring a PCP and a referral to anyone else, the time it takes to run those traps often exceeds the time we have planned to be in the area. 

That is exactly what caused us to step back from fulltime RV life and revert to part-time. With Pam having had both her ankle and her hip replaced with metal, major stomach issues and procedures, and last year back surgery, we were not only restricted in travel time but found it very difficult for her in an RV and for me to assist her in it. But life has been good to us and we continue to use our RV for months at a time, which helps us deal with missing life on the road. 

11 hours ago, mptjelgin said:

Some of the folks commenting on this thread are essentially off the road or in a fixed location for months at a time,  not to mention being on Medicare, which makes a difference in how you pursue medical care. 

Access to Medicare does change some aspects of the healthcare issue, but health problems and issues related to have a far greater impact on the ability to continue as a fulltimer. We were fortunate to have had healthcare  insurance provided by my past employer for our years prior to age 65 and that was also before the passage of the ACA changed the playing field so totally. But I have not forgotten what fulltime travel was like and we still spend as much as five continuous months on the road too keep us pretty current on most aspects of RV life. It is very important to remember something that we had failed to grasp as we went on the road for life. The part that we failed to fully realize was that twenty years of even the best retired lifestyle would still require us to experience twenty years of physical aging and all of the physical changes that age brings. 

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2 hours ago, Kirk W said:

The part that we failed to fully realize was that twenty years of even the best retired lifestyle would still require us to experience twenty years of physical aging and all of the physical changes that age brings. 

This is the biggest thing - as we age the body starts to fall apart.  Doesn't matter who you are, our bodies will not go on forever.   

 

 

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I am a full-timer and pretty much keep moving.  I prefer state and national parks, and I am still in mostly tourist mode even after several years on the road. 

I have traditional Medicare with a Plan F supplement through United Healthcare, which means I never need referrals.  I see my regular physician in Ohio when I can, but I have visited a lot of urgent care centers as I have traveled 136,000 miles in 7 years.  I also had hand surgery twice while staying near my son in northern California.  In addition, I am participating in a research study in Oregon, so my oncologist is there.  (Had to spend four months in a commercial campground while getting treatment.)  My primary physician in Ohio is fairly new to me, but I sent her my records from my original Michigan doctor when i first started seeing her, plus I send her any doctor's reports on surgery or major issues.  She gives me a year's worth of refills on my prescriptions. 

In addition, I carry copies of test results and doctors reports after visits with me as I travel.  I tend to have a lot of kidney stone problems, so I even try to get DVDs of my most recent cat scans if it looks like I might have a problem again soon.  In addition, my Ohio doctor is part of a major medical center, and they have records on a patient portal that I can access very easily.  Did it a couple of times from my cell phone while in a doctor's office.  Electronic records are becoming much more common, which makes it easier to show urgent care doctors my medical history and any relevant test results.  In the last 6 months, I have had cataract surgery, kidney stone surgery, and shingles.  In Ohio, I recently saw a pulmonologist and had  a PET scan for a blob in my lung, which luckily was negative.  I had taken my cat scan that first showed this blob with me from Oregon on a DVD, so did not have to repeat any tests. 

The key is keeping copies of test results and doctors' reports and communicating these with my primary and oncologist.  I have never had problems with a new doctor not believing me that I have a condition because I have had so much documented.   And, all it takes is a quick repeat cat scan showing my kidney stones to get opioids.  Keeping copies of such things also prevents having to have tests repeated.  And because I pay $240 per month for my Plan F, I have never had a copay in many years, other than for prescriptions. 

Edited by Solo18

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Is $240 a month for one person? In my case United Health Care AARP wanted $640 per month for two of us. That is $7,680 per year.

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24 minutes ago, whj469 said:

Is $240 a month for one person? In my case United Health Care AARP wanted $640 per month for two of us. That is $7,680 per year.

Most Plan F premiums are age-dependent. My wife and I currently pay roughly $400/mo to Humana (total) for our Plan F premiums

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