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

Question

Larry Dalton · Accepted 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.

Scott Sims · 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

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

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.

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

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

Agents: Share Your Expertise

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A non-government resource website