How Does Concierge Medicine Work with Insurance?

Switching to concierge medicine can be confusing, especially when it comes to understanding how your health insurance fits in. You're probably asking questions like: How does insurance work with concierge care? Will my plan cover medical expenses? What about the membership fee? 

At PartnerMD, we've helped thousands of patients navigate the shift to concierge medicine since 2003. We know these questions well, and we're here to guide you through the process. 

In this article, we’ll break down three key things you need to know about how concierge medicine works with health insurance, so you can make the best decision for your health and your wallet. 

1. Does health insurance at a concierge medicine practice work the same as a traditional primary care practice?

Many concierge medicine practices do accept health insurance.

You will be responsible for a co-pay, just like at most medical appointments, while your health insurance can cover procedures, prescriptions, and other medical expenses covered under your plan. 

Upon joining a concierge medicine practice, you will provide your health insurance information so the practice has it on file, and they will submit any medical expenses to your carrier for coverage.

If a practice does not accept health insurance, it is likely better classified as a direct pay primary care practice. These practices do not accept health insurance at all (although you should maintain some form of insurance for major emergencies) and require you to pay out of pocket for any care you receive.

2. Does health insurance cover concierge medicine membership fees?

Concierge medicine practices typically have two different types of fees – medical fees and membership fees. Medical fees are what we discussed above – procedures, prescriptions, etc.

As mentioned, your health insurance will cover these the same way at a concierge practice as it would at traditional primary care practices.

Membership fees reference the cost of becoming a member of the practice, which is often a monthly or annual fee. 

Typically, the cost of concierge medicine can range from $2,000-$3,500 per year, depending on the practice. At PartnerMD, our membership costs $2,500 per year or $208.33 per month. 

Your health insurance will not cover the membership fee. Health insurance only applies to expenses for medical care provided.  

3. Medicare and Medicaid in concierge medicine: What you need to know 

If you’re a Medicare patient exploring concierge medicine, be sure to confirm before you join if the practice accepts Medicare.

Some concierge practices will take Medicare – including PartnerMD – while others will not.

Unfortunately, most concierge practices will not accept Medicaid, including PartnerMD.

Concierge Medicine and Health Insurance at PartnerMD

Now that you clearly understand how concierge medicine works with your health insurance, including the details about membership fees and coverage through Medicare or Medicaid, it’s time to take the next step. 

At PartnerMD, we accept most major health insurance plans and Medicare, making sure your healthcare experience is smooth and comprehensive. However, we do not accept Medicaid or TRICARE. 

You can view all of your accepted plans here. However, we do recommend double checking via your insurance carrier's website. 

If you’re interested in learning more about concierge medicine, click here to download our eBook.