Does Medicare Cover Concierge Medicine? What Medicare Beneficiaries Should Know

Each fall, millions of Americans review their coverage during Medicare Open Enrollment, which runs from October 15 to December 7. It is a natural time to think not only about which plan to choose, but also about the kind of care experience you want in the year ahead.

For many people approaching or already enrolled in Medicare, that question leads to concierge medicine. One of the most common questions we hear is simple: does Medicare cover concierge medicine? The short answer is that Medicare does not pay the membership fee, but it can still cover the eligible medical services you receive. Below, we explain how the two work together.

The Short Answer

According to Medicare.gov, Medicare does not cover concierge care membership fees. Medicare states that you pay all costs for non-covered services, including the membership fee for concierge care.

However, a concierge membership does not replace Medicare. If a concierge practice participates in Medicare, your covered services, such as eligible office visits and diagnostic tests, can still be billed to Medicare in the usual way. The membership fee is a separate cost that pays for the enhanced access and services the practice provides.

How Medicare Rules Apply to Concierge Practices

Medicare has specific rules for physicians who offer concierge care. According to Medicare.gov:

•       Physicians who accept Medicare assignment cannot charge a membership fee for services that Medicare already covers.
•       If a practice recommends an item or service that Medicare does not cover, it must provide an Advance Beneficiary Notice of Noncoverage (ABN) so you know in advance that you may be responsible for the cost.
•       The membership fee is paid for services and features outside of what Medicare covers.

In other words, Medicare continues to do what it was designed to do, while the membership provides a different layer of care on top of it.

What Medicare Covers, and What It Was Not Designed to Do

Medicare is a valuable program that covers a wide range of medically necessary services. It was not, however, designed to pay for time, access, or the kind of ongoing relationship that many people want with their physician.

One example is the Medicare yearly wellness visit. Many beneficiaries assume it is a full physical exam. According to Medicare.gov, the yearly wellness visit is “a conversation-based visit with your doctor or other health care provider to create a prevention plan. It isn’t a routine physical exam.” It includes routine measurements, a review of your history and prescriptions, and a written prevention plan.

That is an important service. Still, many people want more: longer appointments, a more comprehensive review of their health, and a physician who can be reached when questions come up between visits.

Medicare generally helps pay for	A concierge membership is designed to add
Eligible medically necessary office visits	Longer, unhurried appointments
Covered preventive services and screenings	A dedicated physician who knows your history
Covered diagnostic tests	Same-day or next-day scheduling
A yearly wellness visit focused on a prevention plan	Direct access to your care team between visits
Covered hospital and specialist care, depending on your plan	Coordination of care across specialists and settings

 Coverage depends on your specific Medicare plan. Please confirm details with Medicare or your plan.

Why Many Medicare Beneficiaries Choose Concierge Care

As people age, health needs often become more complex. Managing several medications, coordinating with specialists, and staying ahead of chronic conditions all take time. In many traditional practices, physicians care for a large number of patients, which can make it difficult to spend extended time with each one.

Concierge medicine takes a different approach. By caring for a smaller number of patients, concierge physicians have more time to focus on prevention, early detection, and coordination. For many members, this means fewer missed details and a more complete understanding of their health over time.

This is where the value of a membership becomes clear. Insurance, including Medicare, helps pay for care. A concierge membership helps you get more from that care through access, time, and continuity.

Questions to Ask During Open Enrollment

If you are reviewing your coverage this fall and considering concierge care, these questions can help guide the conversation:

•       Does the concierge practice participate in Medicare, and which plans does it work with?
•       What is included in the membership, and what is billed to insurance?
•       How quickly can I be seen, and how do I reach my physician between visits?
•       How does the practice coordinate with specialists and hospitals?

To learn more about how our practice works with insurance in general, see our article on how concierge medicine works with insurance. You may also find our guide to the Medicare Annual Enrollment Period helpful.

An Investment in Your Health

A concierge membership is not an inexpensive choice, and it is not meant to replace your insurance. It is an investment in a different kind of relationship with your physician, one built around time, access, and a proactive approach to your health. For many Medicare beneficiaries, that investment brings peace of mind that is difficult to find elsewhere.

The information in this article is general in nature and is not insurance or financial advice. For a more specific look at your own health and coverage, please contact your Hoag Concierge Medicine physician or our office. If you are not yet a member, contact our office to learn more and get started.

Frequently Asked Questions

Does Medicare pay for a concierge doctor?

Medicare does not pay the concierge membership fee. However, if the practice participates in Medicare, eligible covered services may still be billed to Medicare.

Can I keep my Medicare plan if I join a concierge practice?

In most cases, a concierge membership works alongside your existing coverage rather than replacing it. Please confirm the details with the practice and your plan.

Is the Medicare yearly wellness visit a physical exam?

No. According to Medicare.gov, the yearly wellness visit is a conversation-based visit to create a prevention plan and is not a routine physical exam.

When is Medicare Open Enrollment?

Medicare Open Enrollment runs from October 15 to December 7 each year.

Disclaimer: This article is provided for general informational purposes only and is not intended to be medical advice, diagnosis, or treatment. It should not replace a consultation with a qualified healthcare professional. If you have any questions about your health or the topics discussed in this article, please contact your doctor or the Hoag Concierge Medicine office.