I'm considering concierge medicine but already have Medicare. How would these work together?

Question

Scott Sims · Accepted Answer

I have met with a local concierge Dr and she requested that if working with Medicare advantage, PPO plans would be a good fit since they are not in-network with the Medicare advantage plans. As of recently, one of the local health plans told me their HMO plan does work with concierge. So it sounds like they are more flexible now, don't need a PPO is what I've been told!

Answered by Scott Sims on April 9, 2025

Broker Licensed in OR, AZ, CA & 15 other states

Answered by Scott Sims Medicare Insurance Agent

Larry Dalton · Answer

Concierge Care will work with Medicare, but doctors may still charge you for some items that Medicare will not cover but may be covered under Concierge Care. Concierge services are not reimbursed by Medicare.   

This is good for having an extra layer of coverage. The premium for this coverage is not covered under Medicare, so this is one way to get extra insurance coverage and your Medicare. Medicare Advantage networks also work with Concierge.

Medicare does not reimburse concierge services, which provide this enhanced care.

Gary Church · Answer

You can choose any kind care you need, whether it's covered by your Medicare plan or you'll pay out of pocket.

Steven Bleicher · Answer

If you are willing to pay the steep price for a concierge doctor, be aware that some of them do NOT accept Medicare for payment. The trade-off is that the doctor is beholden to you 24/7. This means that you will get his cell phone number and thus, you can reach out to him/her at 3 am, if need be. The added responsibility on your part is that though you are paying upwards of $2,500.00 per year to become their patient, you will still be billed at his menu of pricing for any treatment provided. Since these doctors abhor the Medicare paperwork, this is one of their motivations to transition to a “CD”. Just be careful that his “bedside manner” jives with your own personality!

Answered by Steven Bleicher on May 19, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Fred Manas · Answer

Concierge medicine, where you pay a retainer for access to enhanced primary care, can work with Medicare, but it's important to understand how they interact. While the membership fee itself isn't covered by Medicare, many concierge practices still bill Medicare for the covered services they provide. 
Here's a breakdown:
Membership Fee:
You'll pay the retainer to the concierge practice, and Medicare won't cover this fee. 
Covered Services:
For services typically covered by Medicare (like doctor's visits, lab tests, etc.), the concierge practice can bill Medicare, just like a traditional doctor's office. 
Acceptance of Medicare:
Some concierge practices do accept Medicare and must follow Medicare rules, which means they cannot charge extra for services that Medicare covers. 
Considerations:
If you are on Medicare, be sure to ask the concierge practice about how they bill Medicare and whether they participate in Medicare. 
The membership fee can cover things like more frequent visits, 24/7 access, or a higher level of care, which may be valuable even if not directly covered by Medicare. 
You may need to use your Medicare Supplement insurance for costs not covered by Medicare's 80% payment. 
Some concierge practices may not be suitable for Medicare patients, depending on their specific billing practices and services.

Steve Brauer · Answer

Concierge medicine is usually not affiliated with or accepts any type of insurance coverage. I've heard that Concierge doctors' offices often bill Medicare for some of the services performed by their doctors, but I would not count on that to be the case 100% of the time.

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Vachik Chakhbazian · Answer

they can work together. but Medicare doesn't cover the membership fees for concierge care. You'll need to pay the membership fee out-of-pocket, but your Medicare Part B may cover services provided by a concierge physician that would normally be covered under Part B.

Answered by Vachik Chakhbazian on April 15, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Marcie Barnes · Answer

Concierge medicine is essentially cash pay for doctors who not to take insurance.  A provider must Medicare approved in order for you to seek reimbursement for services.

Suzanne Lamperti · Answer

Unfortunately this reticular type of medicine is not covered. I don't know anything about this type of medicine but when I looked at up to see I'd Meducare would cover, it's not covered at all.

Joshua Filmore · Answer

First question: Does the concierge doctor still take Medicare—and, if you’re on a Medicare Advantage plan, are they in that plan’s network?

Yes, they take Medicare / they’re in‑network: Medicare (or your Advantage plan) pays for covered services and your annual out‑of‑pocket cap still applies. You pay the separate membership fee for the “white‑glove” perks.

No, they’ve opted out / they’re out‑of‑network: You pay the membership fee and every penny of each visit; your Advantage safety‑net max won’t help you here.

So it boils down to a dollars‑and‑cents decision. Is the VIP access worth the extra fee, and will staying in‑network keep your costs predictable? That’s where a licensed Medicare broker (hi, that’s me!) earns their coffee. Helping you crunch the numbers, check networks, and see if concierge care fits your budget without blowing the roof off your out‑of‑pocket limit. Reach out and we’ll sort it out together.

Sonya Fortner · Answer

Medicare will not cover concierge medicine because the concierge provider will not file a claim to Medicare because they are not contracted with Medicare.