What Is Concierge Medicine?
A membership fee, a smaller practice, and a contract. Here is what the term means, what it leaves out, and why two concierge practices can look nothing alike.
3 min readBy Concierge Med Near Me
Photo: Vitaly Gariev / Unsplash
A working definition
Concierge medicine is a way of organizing a medical practice in which patients pay a recurring membership fee, sometimes called a retainer, in order to be part of the practice.
Medicare.gov describes it this way: concierge care is when a doctor or group of doctors charges you a membership fee before they will see you or accept you into their practice. The same page notes that the model goes by several names, including concierge medicine, retainer-based medicine, boutique medicine, platinum practice, and direct care.
That is the whole definition. Everything else, including what the fee buys, how visits are billed, and how quickly you can be seen, is decided by each practice and written into its membership agreement.
Varies by practice. "Concierge" is a label, not a standard. Two practices using the same word can differ on price, included services, and whether they bill your insurance. Read the agreement, not the label.
What the membership fee usually pays for
Most concierge practices describe their fee as paying for things that insurance does not: easier access to the physician and more of the physician's time. Common examples include:
- Same-day or next-day appointments when you are sick
- Longer scheduled visits
- Direct contact with the physician by phone, text, or email
- A more extensive annual wellness visit
- Help coordinating care with specialists
These are typical marketing descriptions, not guarantees. The American Medical Association's ethics guidance on retainer practices says physicians who offer them should present the terms clearly and bill transparently, and that the care itself should meet the same standard for every patient.
Why practices can offer this
The mechanism is simple: fewer patients per physician. When the U.S. Government Accountability Office surveyed concierge physicians, they reported caring for an average of 491 patients, compared with an average of 2,716 before they converted their practices. That survey is from 2004, so treat the numbers as history, but the basic trade is the same today. The membership fee replaces the revenue lost by seeing fewer people.
What the fee does not pay for
A membership is a contract with one practice. It is not health insurance. HealthCare.gov's description of minimum essential coverage lists insurance plans such as Marketplace plans, job-based plans, Medicare, and Medicaid, and practice memberships are not among them.
Outside the membership, you should expect to pay separately, through insurance or out of pocket, for:
- Specialist visits
- Laboratory tests and imaging, in many practices
- Prescription drugs
- Urgent care, emergency care, and hospital stays
- Surgery and other procedures
In many concierge practices, ordinary office visits are also billed to your insurance, which means your usual copay or deductible still applies on top of the membership fee. Our guide to how insurance works with concierge medicine explains this in detail.
How concierge medicine differs from direct primary care
The two models are related and frequently confused. The American Academy of Family Physicians draws the line roughly like this:
| Concierge medicine | Direct primary care | |
|---|---|---|
| Fee | Membership or retainer, often billed annually | Flat periodic fee, usually monthly |
| Insurance billing | Many practices continue to 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 |
There are hybrids and exceptions in both directions. For a fuller comparison, see concierge medicine vs. direct primary care.
Who looks into concierge medicine
People usually start researching concierge medicine for practical reasons: a long wait to see a new physician, short and rushed visits, or a wish to deal with the same clinician over time. Others find out about it when their existing physician converts to a membership model and they have to decide whether to stay.
It is not a fit for everyone. The fee is an added cost, and professional groups have raised fair questions. The American College of Physicians has noted that there is little high-quality, independent research on how these practices affect quality and access, and that they may be out of reach for patients who cannot afford to pay directly. We cover both sides in benefits and limitations.
What to do next
If you are early in your research, three steps will get you oriented quickly:
- Read how concierge medicine works to see what joining and using a practice looks like.
- Read membership costs to understand how fees are structured.
- When you start contacting practices, take our list of questions to ask.
Frequently asked questions
Is concierge medicine the same as direct primary care?
No, although the terms are sometimes used loosely. Concierge practices commonly charge a membership fee and continue to bill insurance for covered visits. Direct primary care practices generally charge a flat periodic fee and do not bill insurance for the services that fee includes.
Do I still need health insurance if I join a concierge practice?
In almost all cases, yes. A membership pays for a relationship with one practice. It does not pay for specialists, imaging, hospital stays, surgery, or emergency care, which is where the largest medical bills come from.
Is concierge medicine only for primary care?
Mostly, but not only. A 2005 federal survey found nearly all concierge physicians practiced primary care. Some specialists and other clinicians, including physical therapists, now offer membership or cash-based arrangements.
Is concierge medicine legal?
Yes. Physicians may enter into contracts with patients, and the American Medical Association publishes ethical guidance for retainer practices. Practices that participate in Medicare must still follow Medicare's billing rules, and state law may add its own requirements.
Sources
- Medicare.gov. Concierge care.
- American Academy of Family Physicians. Direct Primary Care Model for Family Physicians.
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices.
- U.S. Government Accountability Office. Physician Services: Concierge Care Characteristics and Considerations for Medicare (GAO-05-929) (2005).
- American College of Physicians. New policy paper explores impact of concierge and other direct patient contracting practices (2015).
- HealthCare.gov. Minimum essential coverage (glossary).
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.
