March 27, 2025Concierge medicine practices offer many benefits, but do they take Medicare or insurance? It’s complicated. By Tina Donvito Edited by C.J. Trent-Gurbuz March 27, 2025, at 2:27 p.m. Diane Garbini was dissatisfied with all the hassle involved in getting in to see the primary care doctor for her husband, Dennis, 75. He has complex medical needs for which he sees specialists, but she often also needs to contact his primary doctor quickly, such as when he’s sick, has a medical question, needs medication or has another urgent issue. Garbini turned to concierge medicine, an extra service that guarantees quick access to their doctor, among other benefits, for an additional fee. “I decided to try it because with all of Dennis’s issues, something always happens at an odd time of day, and this offers services 24 hours a day, seven days a week,” says Garbini, who lives in Denville, New Jersey. “I can either call or text the doctor, and Dennis will be seen in a couple of hours, or medication will be refilled.” The Garbinis have Medicare and supplemental insurance plans that cover their medical needs, but it was well worth the out-of-pocket yearly fee to join the concierge service their primary care doctor was offering. “If he has a cold or cough, we see the primary first and then seek a specialist if necessary. Because of his complex issues, our primary is copied on everything,” Garbini says. Due to the extra fee and less need for constant access, Garbini herself doesn’t participate in her doctor’s concierge service. “The cost is $1,800 a year – it only covers Dennis, not me, even though we have the same doctor,” she explains. “I have to go through all the hoops to get an appointment.” Garbini’s experience is all too familiar for those who need to see the doctor frequently, such as older people and those with chronic conditions. But how the extra costs of concierge medicine fit in with Medicare and private insurance is complex and may depend on the practice. “There are some cash-only concierge practices that truly don’t accept any insurance coverage, so patients must pay the membership fee and the full cost of their care; other practices accept insurance and bill patients’ insurers for the services they provide,” says Hannah Neprash, an associate professor in the division of health policy and management at the University of Minnesota School of Public Health. We looked into some ways those scenarios might play out. Key Takeaways Many concierge doctors are in network with Medicare and private insurance, and they process claims the same way as a traditional practice. The yearly membership fee, however, is not covered. Generally, you can pay for medical services at a concierge practice through an HSA or FSA account, but most of the time, you can’t pay the yearly fee with funds from these accounts. Direct primary care is another concierge-like model that doesn’t take any insurance or Medicare and often has cheaper yearly fees. Out-of-pocket rates for services may cost less than what you’d pay through a high-deductible insurance plan. Balancing the cost of concierge medicine with the need for greater access and personalized care is a choice every patient has to make for themselves, but older people on Medicare and those with chronic health conditions may find more pros than cons. How Concierge Medicine Works Concierge medicine is a growing trend in health care in which patients pay a set monthly or yearly fee to have better access to their doctor. Services and benefits in this fee may include: 24/7 phone, text and/or email access Same- or next-day appointments Little to no waiting in the waiting room Longer visits with more personalized care More in-depth labs and screenings Preventive planning for health and fitness goals Coordinating with specialists if necessary “Appointments start on time and last as long as they need,” says Dr. Louis Minsky, a family physician in Baton Rouge, Louisiana, who is part of the MDVIP network of concierge doctors. With this additional yearly fee, doctors can take on fewer patients and devote more time to the ones they have. “Practices at MDVIP are capped at 600 patients, as opposed to 2,000 to 4,000 in higher-volume, traditional primary care practices, where they often see 25 to 30 patients in one day for very little time during appointments, 15 minutes on average, and almost no time to address anything beyond the problem of the day,” says Minsky, who is also on MDVIP’s Medical Advisory Board. Medicare and Insurance With Concierge Practices Medicare is a federally funded insurance plan for those over 65, or under 65 with certain medical conditions. Because employer-sponsored health coverage often ends at retirement age (65), this social safety net helps people afford health care as they age and are likely to need it more often. Given the exclusive nature of concierge medicine, do these practices take Medicare and insurance? “There are two parts to this question: the fee for having concierge service – not covered – and the charges for actual medical treatment, which could be covered by the health insurance payer, but not guaranteed,” says Michael Seavers, an assistant professor of healthcare informatics at Harrisburg University of Science and Technology in Pennsylvania. Whether the concierge practice takes Medicare or not, the annual fee, or retainer fee, which usually costs around $2,000 per year or more, is entirely out of pocket. If the concierge practice does take Medicare, or is in-network with private insurances, the medical charges that are separate from the yearly fee are billed similarly to traditional practices. “CMS (Centers for Medicare & Medicaid Services) and commercial health plans could cover specific diagnoses and/or procedure codes from a concierge provider,” Seavers says. “For example, an insurance plan could cover treatment for a broken foot.” Coverage and potential costs is where it gets a little more complicated. Some aspects of well and preventive care might be included in the retainer fee, so those wouldn’t go through insurance. However, if the concierge doctor accepts Medicare, they have to adhere to the Medicare-approved cost of covered services and can’t include additional charges for services that Medicare usually covers. Therefore, they can’t include covered services in the out-of-pocket retainer fee, and patients shouldn’t be charged a larger (or smaller) amount for those services than they would with Medicare. “As crazy as it sounds, a physician can be equally in trouble for charging less than (Medicare) reimbursement rates as well as more; in other words, they have to follow the very strict rules of engagement and constantly monitor changes in policy,” says Dane DeLozier, president of FreedomDoc, a direct primary care practice, which is an offshoot of concierge medicine. Click here to access the full article.