Concierge medicine—also known as concierge care, boutique medicine, retainer-based medicine, platinum practice and direct primary care—is membership-based healthcare that pairs exclusive, personalized care with accessibility and convenience.
For a flat monthly fee, you get unlimited office and telehealth visits that last as long as you need, as well as direct care from a doctor without worrying about copays and other charges. You also gain access to your doctor’s direct phone line for medical questions and simple diagnostic and blood tests in their office. And if you have a major health problem, your doctor coordinates specialist referrals and/or hospital care as needed. With concierge medicine, there’s no insurance or corporate health system interference—just doctors and patients.
Concierge Medicine vs. Traditional Primary Care
A new patient in a large metropolitan area waits an average of 24 days to get an appointment with a traditional primary care physician. Why? Because a traditional primary care provider can have a patient panel of up to 4,000 people and see up to 40 patients a day for no more than 15 minutes at a time.
The traditional primary care physician routine is a familiar one—after waiting weeks for an appointment, you have some basic tests and screenings and wait days or weeks for the results to be uploaded to an online portal. If you’re lucky, you get to discuss your results with a nurse over the phone.
The concierge medicine model, on the other hand, is more about the patient experience. Providers who participate in concierge or direct primary care typically have a patient panel of no more than 600 people. They see six to 10 patients a day and spend at least 30 minutes with each of them. Patients can get same-day or next-day appointments, access advanced tests and screenings more easily, and spend the time it takes to discuss results and develop a personalized care plan with their provider.
The Pros and Cons of Concierge Medicine
- Guaranteed access to care 24 hours a day, seven days a week
- Same-day or next-day appointments
- Standard care, including wound treatment, blood work, physicals and preventative screening, in office
- No copays or deductibles for office visits
- Some common medications are dispensed directly from the office at a discount
- You still need regular health insurance to cover things like hospitalization and specialty referrals
- Membership and monthly fees vary by practice
- Fees increase with age
- Monthly fees paired with regular insurance premiums can be expensive
How Much Does Concierge Medicine Cost?
Depending on where you live and the practice you join, membership fees and monthly costs can range from $1,200 to $10,000 a year. For instance, at ProPartners Healthcare, patients pay a one-time $60 initiation fee and monthly membership fees ranging from $30 to $125, depending on their age. The group also offers family memberships, and those monthly fees are calculated by age but also limited to $200 a month.
Is It Covered By Insurance?
The flat monthly fee for basic concierge or direct primary care is an out-of-pocket expense. Depending on your specific care needs, you might incur additional fees for services like outside labs or executive health assessments. Your health insurance company may reimburse some of these costs if the physician is considered an out-of-network provider.
Concierge care is not an insurance alternative—you still need coverage for hospitalizations and specialty referrals. Since routine care is covered by your membership, though, you can consider switching to a “high-deductible” health plan to save money. Contact your benefits representative or health insurance company to see what can be paid from your health savings account (HSA) or flexible spending account (FSA) as well.
How to Decide if Concierge Medicine Is Right for You
Not all concierge medical practices are created equal. If you’re considering a form of concierge medicine, you need to identify the services most important to you and ask yourself:
- Can I afford a monthly fee on top of the insurance premium I’m already paying?
- How important is it to have 24/7 access to a physician?
- Do I have chronic conditions that require specialists? If so, will I get my money’s worth out of concierge care?
Whatever your needs and budget are Thrive Family Practice has the solution!