Does Medicare Cover Concierge Medicine?

Medicare will pay for concierge care if the doctor — or group of doctors in the practice — accepts Medicare. But Medicare will not pay for any membership fees related to the practice.

Concierge care refers to personalized care from a doctor or group of doctors available to patients who pay a membership fee for services. You must pay this fee before you can receive medical services from the practice.

Paying the membership fee may give you access to services, benefits and amenities that Medicare does not cover.

A concierge service that accepts Medicare must follow all Medicare rules, but more than two in every five concierge practices do not accept Medicare, according to a survey of concierge physicians by Concierge Medicine Today.

It is important to ask whether or not a practice accepts Medicare if you are considering membership in concierge care.

You are responsible for 100 percent of a concierge care membership fee. Membership fees and monthly costs can range from $1,200 to $10,000 a year, according to Forbes.

You may also be responsible for additional fees and charges if the doctor or the practice does not accept Medicare.

A concierge practice cannot charge you extra if it accepts assignment — meaning the doctor or practice agrees to accept payment directly from Medicare and accepts the Medicare-approved amount for the service.

It is important to weigh the pros and cons of a concierge care practice before deciding to join one.

The membership fee to join a concierge care practice typically includes benefits and services that Medicare does not cover. Concierge practices typically focus on smaller groups of patients and quicker service.

Concierge care tends to be popular with those who use it for day-to-day health care. But there are some services that concierge medicine does not deliver. This means you’ll still have to pay for Medicare or other health insurance if you want those services covered.

It’s important to do your homework on the services a concierge care practice offers and how it fits your health care needs.

Also ask for an explanation of how the practice’s billing works — ask about Medicare, your copayments and any other fees you may be charged.

Does the practice offer the type of health care I need?

If you have a serious health condition requiring routine care from a specialist, be aware that it may not be covered through your concierge membership. You may also have to do your own legwork to find a specialist for your condition.

What are the certifications of the practice’s doctors?

Make sure the doctor or doctors at the concierge care practice you are considering are certified by the American Board of Internal Medicine. You can check a physician’s certification at the board’s website. You may also ask about geriatric certification. This means the doctor has a higher level of certification for treating older patients. Also ask if the doctor has admitting privileges with a hospital or medical center. This can get you admitted to a hospital sooner if you need to go to one.

Is concierge care right for you?

If you keep a busy schedule, need same-day appointments for routine health issues and want to spend more time with your doctor during appointments, concierge medicine may be worth considering. But if you have chronic or serious health conditions or limited finances, you should weigh your choices to make sure you’re getting your money’s worth.

Depending on where you live and your circle of friends and acquaintances who are around retirement age, you may hear comments and first-hand stories about concierge care services.

People over the age of 50 make up the majority of concierge care patients, according to AARP. The number of concierge care practices is also clustered in states with larger populations of older adults, such as California and Florida.

It’s important to do your homework before committing to a concierge care practice.