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

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.

Steve and Sue 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 and Sue Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Mike Alexander · Answer

With Concierge medicine , most doctors don't take medicare assignment so you would pay 100% out of pocket. Make sure the doctor also takes medicare, and if he does, you will have to file the claim as most concierge docs won't file vlaims
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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.

Christopher Boyd · Answer

Medicare will not cover the concierge or convenience fee charged by the providers office. Medicare will cover all wellness and preventative care items outlined in 2025 Medicare and You Handbook. After the Annual Part B Deductible Medicare will cover 80% of the Medicare Approved charges for medical treatments. The remaining 20% will be billed to an applicable Medicare Supplement with any applicable co-pays.

Answered by Christopher Boyd on September 24, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

George Ibanez · Answer

Concierge Medicine is paid directly to the doctors and probably your doctor will not bill medicare since he is a concierge doctor and the whole idea of being a concierge doctor is that they do not have to bill medicare or an insurance company.

Answered by George Ibanez on October 17, 2025

Broker Licensed in AR, AL, AZ & 40 other states

Answered by George Ibanez Medicare Insurance Agent

Nikki Rowland · Answer

If you choose to use a Concierge Dr, the annual or monthly fee is paid out of pocket and is not covered by Medicare.
Most Concierge doctors do not accept any type of insurance. You would have to check with their practice to be sure.

Richard Moreno · Answer

Yes, they can bill Medicare like a traditional doctor but won’t pay for any membership. It will also cover labs and testy

Luke Rhoads · Answer

Generally concierge medicine has a membership fee that is not covered by medicare. This provides additional services and benefits that go above and beyone what medicare would cover. You have to make sure the concierge takes medicare, and they are still bound by the billing and practices of the medicare plan that you are on. Co-pays and deductibles would still apply as defined by the plan benefits.

Answered by Luke Rhoads on July 25, 2025

Broker Licensed in OK

Answered by Luke Rhoads Medicare Insurance Agent

Lilyana Uzdenova-Gomez · Answer

How your concierge medicine will work with your Medicare depends on a few factors, some of the most important of which may be: 
1. Does your doctor accept your Medicare plan? If he/she does, will he be submitting your claims to your plan or will he bill you directly and make the claims a part of your concierge care plan u see that agreement? 
2. What exactly is included in your concierge plan? Is it private access to the Dr phone number and care/ consultations outside of the business hours, or is it all of the care that could usually be billable to Medicare? 
3. If you decided to have the concierge care and original Medicare only, without a Medigap or Medicare Advantage plan, you are still responsible for paying original Medicare deductibles, copays and coinsurance. Those bills have No Maximum out of pocket Limit and can keep climbing up to significant amounts quickly when expensive care is needed. 
  In general, your concierge service will make it easier for you to see your covered provider and receive their expert guidance through your healthcare experience, but it will likely not protect you from Medicare related copays, deductible and coinsurance administered elsewhere, unless you have additional coverage, beside original Medicare.

Sandra (Sandy) Steffy · Answer

Here’s the clearest way to think about it: concierge medicine and Medicare can work together, but they operate in completely separate lanes. Medicare continues to cover Medicare‑approved services, while the concierge membership fee is always 100% out‑of‑pocket. The key is understanding what your concierge doctor bills to Medicare versus what your membership fee actually buys you.

Answered by Sandra (Sandy) Steffy on March 30, 2026

Agent Licensed in VA, AL, DC & 7 other states

Answered by Sandra (Sandy) Steffy Medicare Insurance Agent

Michael McGarrigle · Answer

Concierge medicine is separate from Medicare. You pay a membership fee for better access—longer visits, same-day appointments, direct communication—and Medicare does not cover that fee.

Here’s how concierge works with Medicare:

Original Medicare (especially with a supplement):
This is where concierge usually works best. If the doctor accepts Medicare, they bill Medicare for covered services, and your supplement applies as normal.


Most of my clients who use concierge care are on Original Medicare with a High Deductible Plan G—it keeps premiums lower while still giving strong protection for bigger expenses.

Medicare Advantage plans:
This can be more difficult. These plans use networks, and many concierge doctors are out-of-network or don’t participate. That means you could be paying the membership fee and out-of-pocket for care.

If the doctor opts out of Medicare:
Medicare won’t pay at all—you’re fully private pay.

Bottom line:
Concierge care can complement Medicare, but it usually works much better with Original Medicare (often paired with a High Deductible Plan G) than with Medicare Advantage.

Call our office if you still have questions or concerns about Medicare.

Rodney Turner · Answer

Great question! Concierge medicine and Medicare can actually work together quite well, and you're not alone in wondering how they complement each other.

Here's the basic idea: Medicare remains your primary insurance and continues to cover hospitalizations, specialist visits, lab work, and other medical services just as it always has. Concierge medicine — sometimes called a direct primary care (DPC) practice — is a separate membership arrangement you have directly with your primary care physician. You typically pay a monthly or annual fee in exchange for enhanced access and services, such as same-day appointments, longer office visits, 24/7 direct access to your doctor, and more personalized, unhurried care.

The key thing to understand is that concierge doctors generally do not bill Medicare for the primary care services covered under your membership fee. However, if your concierge doctor refers you to a specialist, orders labs, or arranges a hospital stay, Medicare can still be billed for those services as usual.

So in practice, you'd be paying the concierge membership fee out of pocket (typically $100–$300/month depending on the practice), while Medicare continues to handle the bigger-picture coverage.

If you already have a Medicare Supplement (Medigap) or Medicare Advantage plan, it's worth reviewing how those interact as well — some plans may have network restrictions that are worth considering.

Martin Meyer · Answer

You will want to ask your doctor if they accept Medicare, as many concierge doctors do not accept Medicare. That’s not to say there aren’t some that do, it’s just many do not. You can still see them with Medicare, you’ll just pay out of pocket if they don’t accept it, and use your Medicare coverage for care outside of that doctor.

Answered by Martin Meyer on October 8, 2025

Broker Licensed in IL, AL, AR & 18 other states

Answered by Martin Meyer Medicare Insurance Agent

Rebecca Davis · Answer

What a great question, many of our clients are using concierge for their primary care needs but unfortunately for surgeries and hospital stays it just does not work. So keeping your Medicare in good standing with either a Supplement or a Medicare Advantage plan is still recommend. Oh and don't forget you still need the prescription coverage to. 

If your concierge doctor does not take Medicare, then just pay cash for that doctor and keep your medicare up for any other issues that arises that your concierge doctor can not handle. 
Hope this helps.

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

Steven A James, MBA · Answer

From my experience, the two don't actually work together.  Most doctors who decide to provide concierge services do so to avoid dealing with insurance companies altogether.  Here in the Seattle area, providers are typically charging from $2K to $5K.  And this is regardless of the number of visits, if at all.

If you're on Medicare alone or have a Medicare Advantage Plan, these won't help directly ,but would if referred out to providers who would accept billing Medicare and/or the insurance company.

Steven James
Contact me.

Marnie Applegate · Answer

There are concierge practices that will accept Medicare and will bill medicare for services that are covered, but you will still be responsible for your medicare cost-share like copayments, coinsurance and deductibles. If your are on a Medicare Advantage plan the doctor or concierge practice will need to be in network, if not then you will be responsible for all or some of the cost, depending on whether or not your Medicare advantage plan is an HMO or a PPO. You will still need to have Medicare for services not covered by the concierge membership (emergency care, hospital stays etc)

Answered by Marnie Applegate on October 26, 2025

Agent Licensed in TN, AL, GA & TX

Answered by Marnie Applegate Medicare Insurance Agent

Becki Jennings · Answer

Sometimes when people say concierge medicine, they actually mean direct primary care. Direct primary care is usually a clinic offering memberships. Typically they do not bill insurance. If you're referring to concierge medicine, this typically means the provider will bill insurance, but they limit the number of patients that they take. In this case, you would have to confirm that the provider accepts medicare or your advantage plan.

Answered by Becki Jennings on November 29, 2025

Agent Licensed in MO

Answered by Becki Jennings Medicare Insurance Agent

Janet Cruz · Answer

You can use concierge medicine with Medicare but :

Your experience will vary depending on whether  your doctors take Medicare or not. 

You’ll pay out of pocket for the membership fee. 

You’ll still use Medicare for other medical services. 

How it works with Medicare:

Your concierge doctor may bill Medicare for office visit or labs or they may opt out of Medicare all together. It all depends.

Bruce Kaserman · Answer

I believe that you still would need Original Medicare, which is Part A and Part B plus you would need a prescription drug plan , which is Part D. This would have you compliant with all Medicare rules without penalties.

Answered by Bruce Kaserman on May 25, 2026

Broker Licensed in VA, FL, MD & NC, NJ, NY & PA

Answered by Bruce Kaserman 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.

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

Mary Brown · Answer

Medicare still covers medically necessary services (like labs, hospital stays, imaging, procedures, and referrals).
The concierge fee does not replace Medicare, it’s an extra membership cost for enhanced access and service.

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.

Jennifer Kalbach · Answer

Yes — concierge medicine can work with Medicare. But it depends on the practice. Medicare Advantage plans may be more limited. Always check whether your specific plan is accepted.
Most are not compatible with Medicaid.

Barbara Barnes, CMIP® · Answer

Medicare should not coordinate with your concierge medical claims. You are paying a flat amount for a service from your physician, and the physician should not be submitting those claims to Medicare. However, if you need more care than that physician can provide, such as inpatient admission surgery, MRI or more advanced lab testing, that is where Medicare will still be very important.

Answered by Barbara Barnes, CMIP® on August 15, 2025

Agent Licensed in PA

Answered by Barbara Barnes, CMIP® Medicare Insurance Agent

Claudia Englert · Answer

In my opinion, it depends on whether you have Medicare by itself or a Medicare Advantage plan. Medicare Advantage plans have more benefits than straight Medicare & if you have a good Primary Care Physician, I can’t see where you need to pay the outrageous cost charged by concierge doctors that charge anywhere from $1,500. per year up to as high as $10,000. per year.

Answered by Claudia Englert on November 14, 2025

Broker Licensed in OH

Answered by Claudia Englert Medicare Insurance Agent

Raid Alemam · Answer

You can have both however some concierge might not work with Medicare  
And you would have to pay out of pocket for their bill. 
and some might work with and bill Medicare but you still liable for deductible and coinsurance.

Donald Baker · Answer

I would suggest you ask the doctor if he or she accepts Medicare. Then ask them if they accept a Medicare Supplement or Medicare Advantage. That is a start, then you can ask that office what they expect to receive from.

Answered by Donald Baker on February 2, 2026

Agent Licensed in MN

Answered by Donald Baker Medicare Insurance Agent

Tammam Tayara · Answer

Concierge medicine is a private membership model where you pay a fee for enhanced access and services, like longer visits or same-day appointments. Medicare still covers your medically necessary services, tests, and treatments as usual, but the concierge fee itself is not covered—you pay that out of pocket. Many people use concierge medicine alongside Medicare for more personalized care while still relying on Medicare for the bulk of medical costs.

Answered by Tammam Tayara on September 25, 2025

Agent Licensed in CA, NM, OR & TX

Answered by Tammam Tayara Medicare Insurance Agent

Shahnaz Razvi · Answer

Concierge medicine is where you pay out of pocket for medical services.
It can supplement the Medicare coverage but you should know the rules
so you are not overpaying or paying for services you already have coverage for.

Samantha Jones · Answer

You can use any type of concierge, pharmaceutical company or prescription drug delivery. It does not matter but you will pay additional most likely

Sophia Davis · Answer

Concierge Medicine is NOT insurance. This is simply a Membership Fee for a specific Provider or Group of Providers that gives you better access. You are still required to carry Insurance to cover items that are not covered by the Membership Fee i.e hospital stays, other specialists etc. So to answer you question, they do not work together but they both serve a purpose. The Membership Fee covers only what it covers where it covers it and then Medicare covers the rest of what it normally covers.

Answered by Sophia Davis on August 1, 2025

Broker Licensed in OH & PA

Answered by Sophia Davis Medicare Insurance Agent

Kimberly Griego · Answer

Concierge medicine providers do not generally contract with any type of insurance, and charge a fee for access to their services. You would pay them directly for your membership access, and your Medicare would be used for anything done outside of those services, such as lab fees, hospitalization, etc.

Answered by Kimberly Griego on June 9, 2025

Agent Licensed in WA, AZ, CA & 5 other states

Answered by Kimberly Griego Medicare Insurance Agent

Sherri Beach · Answer

Concierge medicine and Medicare can work together, but it’s important to understand how they interact so you can avoid unexpected costs or coverage gaps.

Medicare will continue to serve as your primary insurance for covered medical services like hospital care, specialist visits, lab work, and many routine treatments. Concierge medicine, on the other hand, is typically a membership-based model where you pay an out-of-pocket fee for enhanced access to your primary care provider.

That membership fee is not covered by Medicare, and Medicare generally does not reimburse it. What you are really paying for with concierge care is things like longer appointments, same-day or next-day visits, direct communication with your doctor, and more personalized attention.

Some concierge practices still bill Medicare for covered services, while others operate completely outside of Medicare and require you to pay separately for all care. This is an important distinction to clarify before enrolling.

Also, if you have a Medicare Advantage plan, you’ll want to check your plan rules carefully, because network requirements and billing rules may affect how or if you can use a concierge provider.

Before choosing concierge medicine, it’s a good idea to compare the membership cost with what you already receive through your Medicare coverage and any supplemental insurance. A licensed Medicare agent can help you understand how it fits into your overall healthcare picture so you can make an informed decision.

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.