Concierge Medicine vs. Direct Primary Care
4 min readBy Concierge Med Near Me
The short answer
Concierge practices usually charge a higher fee and still bill insurance for visits. Direct primary care practices usually charge a lower monthly fee that covers visits, and do not bill insurance.
Two models with a shared idea
Concierge medicine and direct primary care, often shortened to DPC, both ask patients to pay a recurring fee directly to a practice. In return, physicians keep smaller patient panels.
Because of that shared idea, the names blur. Medicare.gov lists "direct care" as another name for concierge care. The American College of Physicians uses one umbrella term, direct patient contracting practices, for the whole family.
Still, most physicians and policy groups recognize a practical distinction.
How professional organizations define them
The American Academy of Family Physicians defines direct primary care as a model in which patients pay their physician or practice directly in the form of periodic payments for a defined set of primary care services. Practices typically charge a flat monthly or annual fee under the terms of a contract.
The AAFP also explains the difference from concierge care: direct primary care practices have low monthly fees and typically do not accept insurance or participate in government programs, while concierge practices tend to have higher fees and may continue to bill the patient's insurance for covered services.
Side by side
| Concierge medicine | Direct primary care | |
|---|---|---|
| Fee structure | Membership or retainer, often annual | Flat periodic fee, usually monthly |
| Typical fee level | Generally higher; varies widely | Generally lower; AAFP cites $50 to $100 a month |
| Insurance billing | Many practices bill insurance for covered visits | Generally does not bill insurance for included services |
| What the fee covers | Access and services defined by the agreement | A defined set of primary care services, including visits |
| Cost per visit | Plan cost sharing may apply | Usually none for included services |
| Medicare | Many practices participate; rules apply | Practices often do not participate; ask about opt-out status |
| HSA compatibility (2026 rules) | Typical retainers do not qualify | Qualifying arrangements are compatible, within fee limits |
| Still need insurance? | Yes | Yes, for care beyond primary care |
Varies by practice. These are general patterns. Hybrid practices exist, and a practice's own description of itself is not a reliable guide to how it bills.
The real dividing line: insurance billing
If you remember one thing, make it this question: does the practice bill my insurance for visits?
- If yes, you are paying a fee for access, and your insurance continues to work as usual for the visits themselves. That is the classic concierge arrangement. In a federal GAO survey using 2004 data, about three-fourths of concierge physicians billed insurance.
- If no, the fee is the payment for your primary care. That is the direct primary care arrangement.
The answer affects what you pay per visit, whether network status matters, and how the membership interacts with a health savings account.
Fees
Reliable data is better for direct primary care than for concierge medicine.
- A 2020 Society of Actuaries survey of about 200 direct primary care physicians found average monthly fees of $65 to $85 for adults, depending on age, $40 for children, and $150 for families.
- For concierge medicine, the most detailed federal data is from 2004, when annual fees ranged from $60 to $15,000 and $1,500 was most common.
See membership costs for how to interpret these numbers.
Health savings accounts
This is one area where the label has legal consequences.
Under IRS Notice 2026-5, since January 1, 2026, a person enrolled in a qualifying direct primary care service arrangement can still contribute to an HSA and can use HSA funds for the fees, provided monthly fees do not exceed $150 for an individual or $300 for an arrangement covering more than one person.
The same guidance says an arrangement that charges a membership fee and also bills separately for the services, through insurance or otherwise, does not qualify. That excludes the typical concierge model. Full details are in our insurance guide.
Insurance alongside either model
Neither membership is insurance. The Washington State insurance commissioner's consumer guidance notes that direct practices do not count as required coverage under the Affordable Care Act and suggests pairing a membership with a health plan.
Which should you look at?
Direct primary care may be worth exploring if you:
- Want a predictable price for routine care
- Prefer not to deal with insurance for primary care visits
- Have, or plan to have, separate coverage for major expenses
Concierge medicine may be worth exploring if you:
- Want to keep using insurance or Medicare for covered visits
- Place a high value on access to a particular physician
- Can absorb a higher fee on top of your coverage
Either way, the next step is the same: get the agreement, get the fee schedule, and ask the right questions. For a three-way comparison with traditional care, see choosing the right model.
Frequently asked questions
Is direct primary care cheaper than concierge medicine?
The membership fee is generally lower. The American Academy of Family Physicians says direct primary care fees generally range from $50 to $100 a month. Your total cost also depends on your insurance and what each practice includes.
Does direct primary care take insurance?
Generally no. Direct primary care practices are paid directly by patients through a periodic fee and typically do not bill insurance for the services that fee covers.
Can a practice be both?
Yes. Some practices blend the models, and the terms are sometimes used interchangeably. Medicare.gov lists direct care among the names used for concierge care. Ask how a practice bills rather than relying on what it calls itself.
Do I need insurance with direct primary care?
A direct primary care membership covers primary care only. The American Academy of Family Physicians notes that practices often suggest patients carry a high-deductible policy for emergencies and other care.
Sources
- American Academy of Family Physicians. Direct Primary Care (policy statement) (2024).
- American Academy of Family Physicians. Direct Primary Care Model for Family Physicians.
- American College of Physicians. New policy paper explores impact of concierge and other direct patient contracting practices (2015).
- Medicare.gov. Concierge care.
- Internal Revenue Service. Notice 2026-5 (health savings accounts and direct primary care service arrangements) (2025).
- Society of Actuaries (prepared by Milliman). Direct Primary Care: Evaluating a New Model of Delivery and Financing (2020).
- U.S. Government Accountability Office. Physician Services: Concierge Care Characteristics and Considerations for Medicare (GAO-05-929) (2005).
- Washington State Office of the Insurance Commissioner. Direct health care practices.
We link to primary and authoritative sources where we can. Rules and figures change, so check the linked source for the current version. See our editorial standards.
This article is general education, not medical, legal, tax, or insurance advice. Concierge and direct primary care arrangements vary by practice and by state. Confirm the specifics with the practice, your health plan, or a qualified professional before you decide. Read our medical disclaimer.
