Concierge Medicine: Insurance Or Luxury?

Concierge medicine is a form of membership medicine, where patients pay a membership fee to be part of a practice. This fee is paid directly to the doctor or doctor group and is separate from insurance. The membership fee provides patients with enhanced access to their doctor, including same-day appointments, longer appointments, and faster response times. The cost of concierge medicine varies depending on the practice, with annual fees ranging from $1,200 to $10,000. While some concierge practices only accept membership fees and don't work with insurance companies, others bill patients' insurance for clinical care, similar to traditional practices. Patients are typically responsible for co-pays and deductibles. It's important to note that concierge medicine is not a replacement for health insurance, as insurance is still needed for emergencies and hospitalizations.

Medicare doesn't cover concierge membership fees

Medicare does not cover membership fees for concierge care. If you have Medicare or other health insurance, you can join a concierge medical practice, but you'll have to pay the membership fee yourself. This fee is paid directly to the doctor or doctor's group and can vary depending on the contract or agreement signed.

Concierge Care Explained

Concierge care, also known as retainer-based medicine, boutique medicine, platinum practice, or direct care, is when a doctor or group of doctors charges a membership fee to be part of their practice. This fee gives patients access to services, benefits, and amenities that Medicare doesn't cover. These can include:

• Same-day or next-day appointments
• Longer appointments
• 24/7 access to your physician
• Coordination of specialist care
• Wellness programs and health coaching

Costs of Concierge Care

The cost of concierge care can vary, with annual fees ranging from $1,200 to as high as $10,000 per year. Some practices may also charge additional fees for advanced physical tests, wellness programs, office visits, and cancellation fees. It's important to carefully review the costs and services included in any concierge care plan before joining.

Using Medicare with Concierge Care

While Medicare will not cover the membership fee for concierge care, it can still be used to pay for items and services that the concierge practice doesn't provide, such as:

• Prescription medications
• Emergency department visits and hospitalizations
• Specialist care

Doctors who accept Medicare and participate in a concierge practice must follow all Medicare rules. This means they cannot charge extra for Medicare-covered services unless Medicare won't pay for the item or service. In such cases, the doctor must provide a written notice, known as an "Advance Beneficiary Notice of Noncoverage," listing the services and reasons why Medicare may not pay.

Opting Out of Medicare

Some concierge physicians may choose to opt out of Medicare entirely, which can make it difficult or impossible to adjust their participation in the future. However, this allows them to collect out-of-pocket fees directly from patients rather than billing Medicare for their services.

While concierge care can offer personalized care and quicker access to physicians, it's important to consider the additional costs involved. Medicare will not cover membership fees, and individuals may end up paying more out-of-pocket expenses compared to traditional medical practices.

Concierge doctors may accept insurance for blood work, prescriptions, and lab work

Concierge medicine is a healthcare model in which patients pay a fee—monthly, biannually, or annually—directly to their doctor for the practice's services. This framework is similar to that of a client who keeps an attorney on retainer. Under this model, consumers have access to their doctor or another physician in the practice whenever they want and can make same-day appointments with little to no waiting.

While most concierge medical practices don't take health insurance, if you're in a concierge plan, you may be able to use health insurance for blood work, prescriptions, and lab work. This is because, in some cases, Medicare or other health insurance can be used to pay for items and services that the concierge practice doesn't provide. For example, Medicare Part B (Medical Insurance) covers medically necessary clinical diagnostic laboratory tests when ordered by a Medicare-enrolled doctor or provider.

Additionally, if you have private health insurance, you can join a concierge medical practice but must pay the membership fee yourself. This fee typically includes the normal care received from a non-concierge doctor, plus the added amenities the concierge practice offers.

It's important to note that concierge medicine is not an insurance alternative. You still need regular health insurance to cover things like hospitalization and specialty referrals. However, since routine care is covered by your membership, you can consider switching to a "high-deductible" health plan to save money.

Concierge medicine costs $1,200 to $10,000 per year

Concierge medicine is a membership-based healthcare model that provides patients with exclusive, personalized care, accessibility, and convenience. It is also known as concierge care, boutique medicine, retainer-based medicine, platinum practice, and direct primary care.

The cost of concierge medicine varies depending on the practice and location, ranging from $1,200 to $10,000 per year. The average cost is usually between $2,000 and $5,000 per year. Some practices charge as little as $1,200 to $1,500 per year, while others can charge up to $20,000 per year for more specialized services.

The membership fee for concierge medicine is typically paid monthly, quarterly, or annually. This fee provides patients with unlimited office and telehealth visits, direct access to their doctor, and coordination of specialist care if needed. It is important to note that concierge medicine is not a replacement for insurance, and patients still need traditional health insurance to cover hospitalizations, surgeries, and specialty referrals.

Concierge medicine offers several benefits, including guaranteed access to care, same-day or next-day appointments, longer appointments, and no copays or deductibles for office visits. However, it is important to consider the additional costs, such as fees for advanced physical tests, wellness programs, and office visits, which may vary depending on the practice.

Some ways to manage the cost of concierge medicine include using health savings accounts (HSA) or flexible spending accounts (FSA), employer benefits, and prioritizing spending by adjusting other expenses. It is also essential to read the fine print of any contract and understand the billing process, as concierge practices generally accept and bill insurance and/or Medicare.

Concierge doctors may accept Medicare Part B

Medicare does not cover membership fees for concierge care. Patients are responsible for 100% of the membership fee, which can range from $1,200 to $10,000 per year. However, Medicare or other health insurance may be used to pay for items and services that the concierge practice does not provide, such as prescription medications and emergency department visits.

Concierge medicine is a healthcare model in which patients pay a monthly, biannual, or annual fee directly to their doctor for the practice's services. This provides patients with personalized care and direct access to their doctor, with benefits such as same-day appointments and longer consultation times.

Concierge medicine is a form of membership medicine

The concierge medicine model was introduced in the mid-1990s and was initially called "luxury medical care". Patients paid up to $25,000 per year for this luxury membership on top of their regular health insurance premiums, and it didn't cover the costs of hospitalization or specialist consultations.

The average fee for membership in a concierge practice nowadays is between $1,500 and $2,400 annually, or between $125 to $200 a month. However, the cost of concierge medicine can range from $1,200 to $10,000 per year, and some high-end practices can cost tens of thousands of dollars a year.

Concierge medicine offers several benefits over traditional healthcare models, including:

• Convenient, enhanced access to doctors
• Same-day or next-day appointments
• Minimal waiting times
• 24/7 access to doctors
• More time for doctors to focus on personalized wellness plans and preventative care

However, it's important to note that concierge medicine is not a replacement for insurance. Membership fees don't cover everything, and you'll still need health insurance for emergencies, hospitalizations, specialist care, and other major medical expenses.

Frequently asked questions