How Does Concierge Medicine Work with Insurance?
You want to know the pros and cons. You want to know the cost. And you want also want to understand how concierge medicine works with their health insurance.
This is one of the most common questions we get. And it makes sense.
You understand that concierge medicine requires an upfront membership fee. So, you also want to understand how your health insurance factors in, whether you get it through an employer, your spouse’s employer, the marketplace, or even Medicare.
Here are three things you need to know about concierge medicine and insurance.
1. Your health insurance will work the same way at a concierge medicine practice as it does at 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. Your health insurance does not cover the concierge medicine membership fee.
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 to become a member of the concierge medicine practice, which is often a monthly or annual fee.
Typically, the cost of concierge medicine can range from $1,500-$10,000 per year, depending on the practice. At PartnerMD, our membership costs between $2,300-$2,500, depending on your market.
Your health insurance will not cover the membership fee. Health insurance only applies to expenses for medical care provided.
3. Some concierge practices accept Medicare, but some do not. Most concierge practices do not accept Medicaid.
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
As mentioned, at PartnerMD, we do accept most major health insurance plans. We also accept Medicare patients. However, we do not accept Medicaid or TRICARE.
You can view a PDF of our accepted plans here. However, we do recommend double-checking via your insurance carrier’s website.
You will be responsible for a monthly or annual membership fee. You get an instant quote for the cost of your concierge medicine membership at PartnerMD by using our online cost calculator.
Then, when you come into the office for any kind of medical care, we will submit the expense to your health insurance, just like a traditional primary care practice.