Membership medicine isn’t new, but it’s becoming more popular as patients demand more time with their primary care doctors. These practices allow physicians to do that, but it has its limitations — and some services aren’t covered by health insurance.
Membership medicine is a member-based model of care where a limited number of patients pay a monthly or annual fee to a practice. In exchange, patients have access to medical treatment as well as “enhanced” benefits, like same-day appointments.
Also known as concierge, boutique, or retainer medicine, this model allows physicians to offer more personalized care to their patients.
How does membership medicine work?
The concierge medicine model works in a similar way to a gym membership. You pay an upfront fee to a healthcare practice, and in return you get unlimited visits for primary and preventative care and 24/7 access to your physician.
The average concierge clinic has 500 to 1,000 total patients, or 80% to 90% fewer patients than a traditional practice, according to the American Academy of Private Physicians (AAPP). Since they have a smaller pool of patients, they book fewer appointments and allocate 30 minutes or more to each consultation. It also means they can see patients sooner, and communicate with them between appointments.
Under the membership model, patients also unlock a list of perks — like house calls and comprehensive annual exams — as well as nonmedical services like nutrition coaching.
What does membership medicine cover?
Concierge medicine practices are designed to be your first point of contact for primary and preventative care. The list of services varies between companies, but you can expect this level of coverage.
The information below is general. To find out exactly what a specific practice covers, contact them and ask for a breakdown of their services.
Service or treatment
Expanded access to your doctor
Unlimited visits with your doctor — in-person and telemedicine consults
Same-day or next-day appointments
Average consultation lasts 30 minutes
Short wait times
Basic and extended medical services
Advanced physicals lasting two or more hours
Seasonal and travel vaccinations, like the flu, hepatitis A/B and meningococcal shot
Specialist referrals and facilitation of care
Increased communication with the practice
24/7 access to your care team via electronic platforms, like email, video chat and text
Online patient portal for scheduling appointments, updating medical history and viewing your records
In-office lab work
Diagnostic testing for common illnesses, like the flu and strep throat
Blood testing — your practice may offer hemoglobin tests for anemia, metabolic panels to screen for kidney and liver disease and lipid panels to test cholesterol levels
First-fill prescriptions, such as antibiotics and blood pressure and cholesterol medications
Minor urgent care treatment
Treatment for rashes and skin irritation
Basic injury treatment — like sports taping and casts
Health and wellness monitoring
Diet and nutritional advice
What’s changed during COVID-19?
Many concierge practices expanded access to telemedicine consults to align with social distancing guidelines and patients’ comfort levels.
As a patient, you can likely continue to request virtual consultations — even if your practice has physically reopened their doors.
What doesn’t membership medicine cover?
Most memberships don’t cover the following treatments and procedures:
Complex lab work — including TSH and testosterone tests
Brand-name medications and recurring prescriptions
Imaging — like X-rays, MRIs or CTs
Catastrophic care — like hospitalization and surgery
Major injury treatment
What happens if I need any of those services?
Your practice will help you to find the best specialist, pharmacy, hospital or emergency room, who will then bill through your insurance.
Your doctor will also coordinate your care by transferring your medical records and assisting with any follow-up.
Does membership medicine replace health insurance?
No. While the monthly fee can offset the costs of healthcare, membership medicine isn’t a substitute for health insurance.
Think of it as an add-on. Your membership doesn’t pay for specialist appointments, surgery or hospital visits. You’ll need to pay for those expenses out-of-pocket.
With that in mind, it’s a good idea to supplement your membership with a high-deductible, low-premium health insurance policy that covers catastrophic illnesses and injuries.
How to apply for membership medicine
You’ll typically need to fill out an online application to become a member of a concierge medical practice. The questionnaire will ask for your personal and contact details, as well as your basic medical history.
Once your payment is processed, your membership is active and you can start booking appointments and accessing any associated services.
Some platforms — like Forward — require you to download an app and schedule an initial visit with your doctor. During that visit, your doctor will review your medical records, perform a physical and work with you to develop a personalized care plan.
How long does a membership last?
It depends on the practice, but the minimum commitment is usually six to 12 months.
You can typically choose to pay monthly or annually, with the option to renew your coverage when your membership is up.
How much does membership medicine cost?
The average membership medicine plan costs $51 to $225 per month, according to Concierge Medicine Today. This totals $612 to $2,700 a year — though there are some high-end plans that can set you back more than $30,000 a year.
Some employers offer membership medicine as part of their health benefits, and subsidize the fee — which is an incentive to schedule regular doctor’s visits. Bigger practices like OneMedical even operate on-site clinics at workplaces across the country.
Can I use my insurance to pay for membership medicine?
It depends on your membership medicine practice and the type of coverage you have.
The information below is general. For the most accurate answer, call your insurer’s benefits department and ask about their reimbursement policies.
Type of insurance
How it treats membership medicine
Private health insurance
Your health insurance won’t cover your membership fee, but it might help you pay for the services your practice can’t provide in-house.
Around 75% of membership practices accept insurance, according to AAPP. This means your practice will bill your insurance company for things like recurring prescriptions and advanced lab work.
Some practices also charge a copay or coinsurance for certain visits, but this isn’t common.
Medicare doesn’t cover membership fees for concierge care, which means you’ll pay 100% of your annual or monthly fee out-of-pocket.
But some concierge practices accept Medicare for select services they offer, including OneMedical.
Some practices participate in a limited number of ACA plans purchased on the Health Insurance Marketplace.
If your plan is out-of-network, you’ll need to pay out-of-pocket if you visit a membership medicine practice.
Are membership medicine fees HSA- and FSA-eligible?
It depends on the type of cost. The general rule is that if your insurance covers it, so will your Health Savings Account (HSA) or Flexible Savings Account (FSA).
Spending accounts only apply to medical services that are actually performed or recieved, according to the IRS. So, you can’t use your HSA or FSA to pay your membership fee. But you can use the funds to cover other out-of-pocket concierge expenses, like prescriptions.
Membership medicine is rising in popularity
Around 12,000 physicians across the US practice concierge medicine, according to Concierge Medicine Today. This is a small fraction of the 1 million licensed physicians nationwide — but the publication says the membership model is growing by 3% to 6% annually.
Concierge practices are designed to cover preventive and routine care and coordinate the logistics for you — a strategy known as “quarterbacking.”
These are the major benefits of the concierge model:
Ability to visit your doctor anytime, without having to schedule appointments in advance or wait at the practice
Spend more time with your doctor — consultations typically last 30 to 60 minutes
One point of contact for your basic healthcare needs
Round-the-clock access to your care team to discuss your health, treatment plan and medical records
Visit any of the practice’s locations if you’re traveling
Speak to your doctor outside of office visits
Use your preferred method of communication — whether that’s over the phone, text message or via video or live chats
Discounts on some medical tests and lab work
Access to health and wellness programs
Assistance with referrals if you need specialist care
The drawbacks of membership medicine
The model has its limitations, including the following:
Membership fees can be steep
It doesn’t cover specialist, emergent or out-of-network care
It doesn’t pay for recurring prescriptions
Not all practices accept health insurance — so you may end up paying for some expenses out-of-pocket
It’s an additional healthcare cost on top of insurance
Lack of locations in rural and underserved areas
There’s a possibility your nearest concierge medicine practice has capped its patient load
How to compare concierge medicine companies
If you’re interested in membership medicine, compare practices to make sure you’re getting the most comprehensive coverage for the lowest price.
Consider these factors:
How much is the monthly or annual fee?
What medical services, treatments and procedures are covered?
What non-medical services are offered?
Is there a copay or coinsurance?
Does the practice accept my health insurance?
How many patients does the practice have?
What is the appointment availability like?
What level of communication can I expect to have with my doctor?
How can I get help between in-person appointments?
Is there an on-site pharmacy?
Where is the nearest practice to my home or place of work?
Which specialists and hospitals are aligned with the practice?
You may also want to research the doctors who work at the practice. Some practices offer a free consultation before signing up so you can meet your primary care doctor and make sure you get along.
How to find a membership medicine practice near you
The biggest companies have physical locations across the US. To figure out which practices are near you, conduct a location-based web search or go to a company’s site directly.
If you have a membership through your work, you should be able to learn about the nearest location by reading your benefits documents or speaking to your HR department.
Is membership medicine worth it?
If these situations apply to you, signing up with a membership medicine practice might make sense:
You have a high-deductible health insurance policy and might otherwise pay hundreds or thousands of dollars in out-of-pocket costs over the course of a year.
You have a chronic health condition that requires constant monitoring, like diabetes or heart disease.
You want support with stress, sleep, your diet or weight loss.
You’re elderly and likely to frequently visit a primary care doctor.
Your employer offers membership medicine and covers all or part of the fee.
You’re due for a range of lab tests and vaccinations this year.
In these cases, you could pay less for healthcare by taking advantage of the services membership medicine offers.
But if you don’t anticipate needing to visit a doctor much this year, the fee may outweigh the benefits of membership.
With concierge medicine, patients pay a “retainer” in exchange for unlimited doctor’s visits and more communication with their healthcare team. The model promotes personal, convenient care, but it only covers a limited range of medical services — so it’s best to pair it with a health insurance policy.
That way, if you need to go to a specialist, hospital or emergency room, your insurance will step in to help cover the costs.
Katia Iervasi is a staff writer who hails from Australia and now calls New York home. Her writing and analysis has been featured on sites like Forbes, Best Company and Financial Advisor around the world. Armed with a BA in Communication and a journalistic eye for detail, she navigates insurance and finance topics for Finder, so you can splash your cash smartly (and be a pro when the subject pops up at dinner parties).
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