Concierge doctors offer personalized care with direct access—but how does that fit with your insurance plan? The answer isn’t as straightforward as you might think. Some services are covered, others aren’t, and the rules can vary widely. Before making the switch, here’s what you need to know about how insurance works with concierge doctors—and what it could mean for your wallet.
Interested in concierge services in Queens? Contact us now!
What types of insurance do concierge doctors typically accept?
Concierge medicine is structured around a membership-based model, where patients pay an annual or monthly fee for enhanced access and personalized care. This fee often covers services such as longer consultations, same-day appointments, and direct communication with the physician. Nevertheless, how insurance is used in conjunction with concierge services varies significantly between practices.
According to a report by U.S. News, 51% of concierge practices operate on a cash-only basis, meaning they do not accept any form of insurance. Another 29% accept Medicare or some form of private insurance, while 14% accept Medicare but exclude HMO or PPO plans. A smaller portion—6%—accept private insurance but not Medicare.
Even when a concierge doctor accepts insurance, it’s important to understand that the membership fee is not covered by insurance and must be paid out-of-pocket. Patients are strongly encouraged to maintain traditional health insurance to cover services that fall outside the scope of concierge care, including hospitalizations, specialist referrals, and emergency services.
Which Types of Insurance Do Concierge Doctors Accept?
Concierge doctors differ widely in how they handle insurance, depending largely on whether their practice is insurance-based, cash-only, or follows a hybrid model. While some accept certain insurance plans, others operate entirely outside of the traditional insurance system. Understanding the distinctions can help patients make informed choices.
1. Medicare
Some concierge doctors accept Medicare, but it’s important to note that Medicare does not cover the concierge membership fee. It may cover medically necessary services such as lab tests or imaging ordered during a visit. According to the U.S. Centers for Medicare & Medicaid Services (CMS), providers who opt out of Medicare must have patients sign a private contract agreeing not to submit any Medicare claims for covered services.
2. Private Insurance (PPO, HMO)
A small number of concierge doctors accept private insurance plans, such as PPOs or HMOs. In these cases, the provider may bill the insurer for certain covered services, but the membership fee is always paid out-of-pocket. PPOs are more commonly accepted due to their out-of-network flexibility, whereas HMOs are typically not compatible with the concierge model, as they require providers to stay within a defined network and refer patients internally.
3. Direct Pay or Cash-Only Models
Many concierge physicians operate on a direct pay basis, meaning they do not accept any insurance. Instead, they offer care directly to patients in exchange for a recurring membership fee. This model provides more autonomy in care delivery but may not be ideal for those who depend on insurance to manage healthcare costs.
4. Hybrid Models
Some practices follow a hybrid approach, accepting insurance for specific services while still charging a separate concierge fee for enhanced access, preventive care, and other premium services. While this model offers more flexibility, it can also be confusing for patients navigating insurance reimbursements and out-of-pocket expenses.
Overall, the type of insurance accepted—if any—varies from practice to practice. While patient satisfaction tends to be higher in concierge and hybrid models, studies have shown that these practices often serve fewer patients, partly due to the limitations imposed by insurance compatibility.
What Are the Costs Outside of Insurance Coverage?
In concierge medicine, the most significant out-of-pocket expense is the membership fee, which varies widely depending on the location, range of services, and physician’s experience. On average, patients can expect to pay between $1,200 and $10,000 annually, though some elite practices may charge upwards of $100,000 per year.
This membership fee typically includes services such as comprehensive annual physicals, same-day or next-day appointments, extended consultation times, 24/7 access to the physician, and preventive care and wellness planning. These offerings are designed to enhance convenience and promote proactive health management.
It’s important to note that specialist visits, hospitalizations, surgeries, and advanced diagnostic tests are generally not included in the membership and are billed separately—often covered by traditional insurance. Some practices also provide family or group discounts and may allow the use of Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) to help cover membership fees, offering added flexibility for patients managing their healthcare budgets.
How to Choose the Right Concierge Doctor for Your Insurance Plan
Selecting a concierge doctor who aligns with your insurance plan and healthcare needs requires careful evaluation of several factors. Taking the time to assess each area will help you make a confident and informed decision.
- Insurance Compatibility
Start by confirming whether the concierge practice accepts your specific insurance plan. Some practices may bill insurance for certain services, while others operate entirely on a cash-only basis. Knowing how your plan interacts with the practice’s billing model is essential to avoid unexpected costs. - Services Covered
Understand exactly what is included in the membership fee. Services such as physical exams, wellness planning, and 24/7 access may be covered, while others like specialist visits or advanced testing may incur additional charges. Make sure that any essential services you expect to use are either included or can be billed to insurance. - Use of HSAs/FSAs
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), check whether the membership fee qualifies as an eligible expense. Using these accounts can offer tax advantages and reduce your out-of-pocket burden. - Physician Credentials and Experience
Research the doctor’s credentials, clinical background, and areas of specialization. Patient reviews and testimonials can also provide insight into the provider’s approach and communication style. - Practice Accessibility
Consider whether the practice’s location, office hours, and telemedicine options suit your lifestyle. Convenience and access are essential benefits of concierge care, so make sure the logistics work for you. - Trial Periods and Contracts
Some concierge practices offer trial periods or flexible membership agreements. Ask about cancellation policies and any fees that may apply if your needs change.
By reviewing these factors carefully, you can choose a concierge doctor who not only delivers high-quality, personalized care but also fits within your financial and insurance framework.
Sources.
Health Affairs. (2020). Concierge Medicine and the U.S. Primary Care Landscape.
Centers for Medicare & Medicaid Services (CMS). (2022). Private Contracting.
Rylands, K. S., Collins, C. M., & Collins Jr, D. R. (2025). Maximizing the Value of Concierge Medicine: A Systematic Review of Cost, Access, and Outcomes. The American Journal of Medicine.