How Does Concierge Medicine Work with Insurance
Key Takeaways
With concierge medicine, you pay for a membership fee, but you’ll also need health insurance coverage to cover sick visits and health care beyond primary care.
How Does Concierge Medicine Work with Insurance? A Definitive Guide?
People who pay a membership fee for concierge care often wonder if they still need health insurance. The answer is yes. Here, we explain the difference between concierge membership or retainer fees and insurance coverage, and when and how they overlap.
Do Concierge Practices Accept Health Insurance?
Many concierge practices accept health insurance. However, your health insurance cost is separate from any membership fees.
You can think of membership fees like an out-of-pocket healthcare cost. If a concierge practice accepts insurance, you use your insurance just like you would at a traditional primary care provider – for sick visits and follow ups that are covered by your insurance provider, be it Medicare or commercial. Your insurance won’t pay your membership fee, though, since it’s not considered a covered medical expense.
Some concierge medical practices choose not to accept any health insurance. Instead, your fee covers all the services you receive from your concierge doctor. You might hear this type of concierge practice referred to as “direct primary care,” though there are plenty of DPC practices that are not concierge.
What Does the Concierge Membership Fee Cover?
A monthly, semiannual, or annual concierge membership fee covers services your insurance doesn’t. The fee pays for preventive care that goes beyond what your insurance may cover and additional personalization.
Although not included in the fee, many programs may also offer convenience benefits such as:
- Communication with your doctor after hours or on weekends
- Same- or next-day appointments that are always with your doctor
- No waiting room delays
- Longer visits that don’t feel rushed
- More advanced wellness screenings and tests
Concierge doctors often see fewer patients. That means they have time to develop a more personal patient-physician relationship with you and understand your healthcare needs.
Why Do I Still Need Insurance Coverage?
Even if you pay a fee for a concierge doctor, you should still carry health insurance. Some concierge practices will bill your insurance for primary care services, such as sick visits.
Health insurance can cover other healthcare costs for services you may need, such as:
- Care from specialists
- Hospital visits
- Perscrptions
Some people opt for a high-deductible health insurance plan if they think they will be covered for most of the healthcare they’ll need. Others maintain their current plan, especially if they see a specialist or other doctors regularly.
How Does Concierge Medical Billing Work?
The concierge medical billing process depends on whether your concierge doctor accepts insurance. Either way, you pay both your health insurance premium and your membership fee — and both work together to get you the healthcare you need.
For example, let’s say you see a concierge doctor, and the annual fee is $2,500. Your monthly insurance premium is $300. Your concierge practice accepts insurance. When you have a sick visit, they submit that service to your insurance. You owe any co-pays or deductibles based on your specific insurance plan.
Because you also pay the membership fee, you receive additional care that your doctor doesn’t bill to your insurance. They might provide a full body scan or use technology that measures your metabolism. Normally, insurance wouldn’t cover these services, but your membership fee does.
If you see a doctor who is not your concierge doctor, then that doctor bills your insurance for any medical services.
How Do I Find a Concierge Practice?
There are many ways to search for a concierge practice. It’s important to find one that meets your health and wellness needs. You also want to make sure you understand if the practice accepts insurance and what that means for the services you receive.
Organizations like MDVIP can help make the search easier. Often compared to concierge practices, MDVIP-affiliated practices go beyond concierge medicine. Our affiliated doctors provide a personalized wellness plan made specifically for you. From cardiovascular assessments to advanced disease screenings, their goal is to identify health risks before they become medical problems.
MDVIP membership works with Medicare and commercial insurance, so you keep your coverage and use it how you do now. Your membership fee covers the cost of the MDVIP Wellness Program, which includes advanced tests and diagnostic screenings not usually paid for by insurance. Check with your MDVIP-affiliated physician to find out if they accept your insurance. The membership fee is also compatible with HSA/FSA programs.
Learn more about how the MDVIP model can meet your specific health needs.