Young adults will usually transition from pediatric to adult care between ages 18-21. Below you'll find helpful information about transitioning to adult care. 

It’s never too early to know about your medical conditions and how they are treated. Usually you’ll need to start seeing an adult provider between ages 18 and 21, depending on your current doctor’s policy.

It is important to have a provider who has experience caring for people your age, because your health care needs may change once you become an adult. Internal medicine doctors or family medicine doctors can be your primary care physician. If you need a specialist for a medical condition, find a specialist who cares for adults.

There are a lot of different ways to find a new doctor. Ask your current provider if there is someone he or she recommends. You can also call your insurance provider or check its website for a list of options.

How to make (and go to) your own appointment

• The provider’s office phone number is on their website. When you call, state that you would like to make a “new patient” appointment.
• The receptionist will ask you for some information, usually your name, birthdate and insurance information.
• While you’re still on the phone, be sure to ask if there is a “new patient questionnaire” or form that you should fill out before your appointment.
• Ask if there is a copay or other expected payment for your appointment and what forms of payment they accept.
• Arrive a few minutes early for your appointment and check in at the front desk.
• Keep a list of questions you want to ask. Bring it to your appointment. Remember that your provider can only help with the things you share with them.

Transition checklist: Take charge of your own health

• Request time to talk to your pediatrician about your transition process.
• Know your medical conditions and diagnoses.
• Know the names, dosages and how often you take your medications.
• Find an adult primary care provider and adult specialists if you need them.
• Begin making your own appointments.
• Don’t forget to write them on your calendar and/or put them in your phone’s calendar.
• Choose a pharmacy to fill your prescriptions.
• Take pride in beginning your journey to adulthood!

Fast Facts About Insurance

Q: What’s the difference between a PPO or HMO?

A: There is a lot to know, but in general, a PPO allows you to choose from different providers and an HMO requires you to stay within a smaller group of providers for your care.

Q: How much do I pay at my appointment?

A: Usually you’ll be responsible for a portion of your health care expenses. A copay is set amount that you pay at the visit. This may be different for visits with your primary care doctor, your specialists and a visit to the Emergency Center. Coinsurance is a percentage of the total cost of the visit that you may have to pay.

Q: How do I know if certain procedures or medications are covered?

A: Different insurance plans provide different amounts of coverage. Call the number on your insurance card and ask a representative for help.

Q: How do I get insurance?

• You might be covered on your parents’ insurance until you are 26.
• College students may be able to get insurance coverage through their school for a fee.
• You may qualify for Medicaid or Medicare depending on your situation.
• Ask your doctor if the clinic has a social worker or care coordinator who can help you find insurance coverage.

The information here is not intended to be nor should be used as a substitute for medical evaluation or treatment by a health care professional. This publication is for information purposes only and the reader assumes all associated risks.

Content experts: Sarah Czack, M.D., Johnae Snell, M.D., and Jasmine Reese, M.D., M.P.H.

Resources:

• gottransition.org
• AAP. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics; 2018: 142 (5). Doi: e20182587