Does Medicare Cover Concierge Medicine?

Concierge care is when a doctor or group of doctors charges you a membership fee before they’ll see you or accept you into their practice. After you pay the membership fee, you may get some services or amenities that Medicare doesn’t cover. Concierge care is also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care.

Doctors who offer concierge care must still follow all Medicare rules, including the following:

• Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means your membership fee can’t 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 Medicare doctors (whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover.

You pay all costs for non-covered services, including the membership fee for concierge care.

Note: Your membership fee depends on the contract or agreement you sign with the doctor or doctor group. Additional state laws and consumer protections may apply. For more information, contact your state’s insurance department or consumer protection bureau.