What Does Concierge Medicine Cover?

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Concierge Medicine, also known as Retainer Medicine, Membership Medicine, or Boutique Medicine, is a primary care physician practice that charges an annual fee to patients in exchange for enhanced medical care.

Concierge healthcare offers a more intimate doctor-patient relationship through a more personable, one-on-one relationship with their doctor. The concept of concierge healthcare revolves around the theory that patients would be willing to pay fees for enhanced healthcare.

The concept of concierge healthcare

A core element of concierge medicine is that physicians limit the size of their practice to increase the time available to spend on patient care. The concept basically entails a situation whereby patients pay a set annual fee or retainer, and in exchange, physicians provide superior customer service, personalized care, and better doctor care. Taken at face value, the concierge medical model creates an entirely new stratum of healthcare quality and delivery through an upgraded scope of services with a cap of no more than 400-600 patients per primary care doctor.

Concierge medical practice

Concierge medical practices enhance patient-physician relationships by implementing a model of care that benefits both patients and physicians. For patients, this means direct access to their doctors 24 hours a day via home phones, mobiles and emails, same-day appointments, and more undivided attention with longer physician face time, little to no waiting time, and a focus on personalized preventive care. For physicians, this means more time nourishing individual patient relationships, a focus on preventive care, and a direct reimbursement reflecting the value of their time and services. Many physicians are attracted to this new physician-patient relationship as they become more disappointed with: lower reimbursement rates, claims processing hassles from payers, delayed payments, greater administrative burdens, increasing overhead, and higher costs, particularly in the area of malpractice premiums, and the like.

Concierge care coverage

Medicare does not cover membership fees for concierge care; patients must pay 100% of the concierge care membership fee. This membership fee is governed by the contract or agreement they sign with the doctor or doctor group. Additional state laws, regulations, and consumer protections may apply.

VIP medical services provided may include:

  • 24/7 Triage and coordination of care for medical emergencies and urgencies
  • Same day/next day appointments
  • Physical examinations and comprehensive medical workups conducted in one location and in a manageable time frame
  • Collection of all tests, treatments, and medical records
  • Identification and scheduling with top physicians and specialists capable of diagnosing and treating particular conditions
  • Customized medical research and reports pertaining to particular illnesses, symptoms, concerns, diagnostics, and therapeutic options
  • Customized research reports on medical literature to educate and guide in making informed choices about prognosis and treatment options
  • Coordination and access to medical care while traveling in the USA or outside of the country

Things to know:

Physicians who provide concierge care must still follow all Medicare rules:

  1. Doctors who accept assignment cannot charge you extra for Medicare-covered services. This means the membership fee cannot include additional charges for items or services that Medicare or insurance plans usually cover unless Medicare does not pay for the item or service. In this situation, the doctor must give a written notice called an “Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons for why Medicare may not pay.
  2. Doctors who do not accept assignment can charge more than the Medicare-approved amount for Medicare-covered services, but there is a 15% limit called the “limiting charge.”
  3. All concierge physicians (regardless of whether they accept assignment) can charge for items and services that Medicare and insurance plans do not cover.

In short:

Concierge care is when a doctor or group of doctors charges you a membership fee. They charge this fee before they see or accept you into their practice. Concierge medicine may also be called retainer‐based medicine, boutique medicine, platinum practice, or direct care. When you pay this fee, you may receive services or amenities that Medicare or insurance plans do not cover.

For more information about concierge medicine coverage, contact Concierge Medicine of Jupiter today.



Personalized, Compassionate and Extraordinary Care


Concierge Medicine of Jupiter
2151 South Alt A1A | Suite 950 | Jupiter, FL | 33477
P: (561) 743 – 2239

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