Medicare and Medical Concierge Services

Concierge medicine, sometimes referred to as retainer-based medicine or boutique medicine, refers to a practice in which primary care physicians offer direct services in exchange for monthly membership or retainer fees. Many individuals appreciate the benefits of concierge medicine, which include personalized care and direct access to primary care physicians 24 hours a day. Concierge practices are gaining popularity as an alternative to traditional care, but there are also limitations in terms of insurance coverage. 

Does Medicare Cover Concierge Services?

Medicare may offer coverage for certain medical concierge services if beneficiaries choose practices that accept Medicare. However, it's important to note that Medicare will only pay for actual health services provided. It will not, under any circumstances, pay for membership fees. Survey studies have shown that approximately 2 in 5 concierge practices accept Medicare, so options for beneficiaries may be limited. If a concierge practice does accept Medicare, it must follow all Medicare rules. 

How Do Physicians Bill for Concierge Services? 

Typically, concierge practices bill private insurers and Medicare for covered services and bill clients directly for non-covered services and membership fees. Individuals are generally expected to pay any copayments the same way they would with standard primary care physicians. 

How Much Do Concierge Services Cost?

The costs for medical concierge services can vary greatly depending on the specific practice and services provided. Clients are typically billed for membership fees on a monthly basis, and they can range between $100 and $250 per month. Annual costs can range between $1,500 for basic care and $20,000 for specialized treatments and services.

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What Are Some Pros and Cons of Concierge Medicine? 

One of the most attractive benefits of concierge medicine is the elimination of long waiting times for both the actual appointments and the amount of time individuals spend in the waiting room. While specific offerings can vary per practice, many concierge practices guarantee same-day or next-day appointments, and appointments typically start at the time scheduled. 

In most cases, retaining a concierge practitioner as a primary care physician allows individuals 24/7 access to care. Physicians are typically on call and available for telephone or video call consultations, and most offer emergency services when needed. Concierge practices may also have in-house specialists on staff, which helps reduce the stress of having to wait for referrals or travel to specialists.

The overall cost of services tends to be one of the biggest cons of concierge medicine. While Medicare may cover certain treatment costs through participating practices, it does not cover membership fees under any circumstances. Similar to Medicare, other private insurance companies may assist with some, but not all, costs of concierge medical services. This means individuals may end up paying more out-of-pocket expenses than they would with a traditional medical practice. 

Another downside to medical concierge services is the limited locations. Concierge medical practices aren't located in every state and city, so certain individuals may not have access to this type of service. In areas with limited concierge practices, those practices may be at capacity and unable to take on new clients. 

Are Medical Concierge Fees Tax-Deductible? 

Medical concierge fees are considered tax-deductible medical expenses as long as an individual utilizes the physician's services within the specified tax year and the fee amounts go toward actual healthcare services, such as routine physical exams. If a retainer fee is for access to the physician only without any services included, it can't be written off as a deduction in most cases.  Anyone with questions regarding tax-deductible medical concierge fees should consult with a tax professional to ensure correct filing at tax time.