Concierge Medicine & Medicare
Our clients have increasingly asked about whether Medicare covers concierge medicine. What is Concierge care? It’s when:
- A doctor or group of doctors charges you a membership fee.
- The fee is assessed before they’ll see you or accept you into their practice.
- Concierge care may also be called concierge medicine, retainer‐based medicine, boutique medicine, platinum practice, or direct primary care.
Generally, you pay 100% of the membership fee for concierge care out of pocket. Unfortunately, Medicare doesn't cover membership fees for concierge care.
Things to know
Doctors who provide concierge care must still follow all Medicare rules:
- Doctors who accept Medicare assignment can’t charge you extra for Medicare-covered services. This means the membership fee cannot include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service. In this situation, your doctor must give you a written notice called an "Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons why Medicare may not pay.
- Doctors who don’t accept assignment can charge you more than the Medicare-approved amount for Medicare-covered services, but there’s a 15% limit called the "limiting charge."
- All doctors who accept Medicare – regardless of whether or not they accept assignment – can charge you for items and services that Medicare doesn’t cover.
Ultimately, there is little research on whether concierge medicine offers better health outcomes. But, if you're considering looking into concierge care, you should know that you'll still need to carry Medicare. Indeed, you'll use your Medicare coverage if you have to go to the emergency room or if you have a condition like heart disease that requires you to see a specialist. (In addition, many concierge practices also bill your insurance on top of your monthly fee for reimbursement.)
And if you need a specialist, you may have to do the legwork of finding one yourself. A concierge practice may suggest names, “but you would still need to figure out if they take [Medicare] and, if not, how much you'll be willing to pay,” says Sharona Hoffman, director of the Law-Medicine Center at Case Western Reserve University in Cleveland.