5 Misconceptions about concierge care

As the landscape of healthcare continues to change, many patients are drawn to the concept of concierge care—an appealing option that promises personalized, high-quality healthcare services. However, there are several misconceptions about concierge care that can lead to less-than-optimal decisions, especially for those relying on Medicare. To ensure you can make the best decision for you, let’s clear up five misconceptions about concierge care.

What is concierge care?

Concierge care, also known as boutique or retainer-based medicine, involves patients paying a recurring fee—often annually or monthly—to gain enhanced access to a primary care physician. This model is designed to offer more personalized services that go beyond what standard healthcare plans typically cover. These services can include perks like extended appointment times, 24/7 access to the physician, comprehensive wellness plans, and preventive care strategies.

So far, sounds good. But, there are a few details to consider before you sign on the dotted line.

Misconception 1: Medicare will cover membership fees

One common misconception is that Medicare will cover the cost of boutique care membership fees. This is not the case. Medicare does not cover the annual or monthly membership fees required for concierge care. Medicare only covers specific medical services and treatments, not membership fees for enhanced access or additional services provided under this model. Therefore, patients must pay the concierge fee entirely out of their own pockets, which can be a significant financial burden, especially for those on fixed incomes.

So, if you want access to the exclusive services concierge care provides, you have to be willing to fork over the costs. These fees are out-of-pocket expenses that range on average of $2,000-$5,000 annually.

But, if you have some unused HSA funds sitting around, the costs for retainer-based medicine can sometimes be covered with these funds.

Misconception 2: You don’t need health insurance if you have concierge care

Another myth is that having this membership eliminates the need for traditional health insurance. This is a dangerous misconception that can lead beneficiaries to gaps in coverage.

This elevated primary care service typically covers exactly that: primary care services. But it does not cover hospital stays, surgeries, specialist visits, emergency care, or prescription drugs. Without comprehensive health insurance, patients would be responsible for all these costs, which could be financially devastating. Therefore, health insurance is still necessary to cover major medical expenses that concierge care does not address.

Misconception 3: Concierge care covers everything Medicare doesn’t with no out-of-pocket costs

Some believe that concierge care will cover all the gaps in Medicare without any additional out-of-pocket expenses. This belief is misguided and can lead to unexpected financial obligations.

While concierge care offers many additional services, it does not cover all out-of-pocket costs. For instance, things like outpatient services, vaccinations, and advanced diagnostic tests are not typically included in the concierge fee. Patients still need to pay for these services either out-of-pocket or through their health insurance. Moreover, boutique care fees are additional expenses on top of any co-pays, deductibles, and premiums associated with Medicare or other insurance plans.

Misconception 4: All concierge care doctors automatically accept Medicare assignment

There is a misconception that all concierge care doctors accept Medicare assignment. This means they agree to the Medicare-approved amount as full payment for services.

Not all concierge care doctors accept Medicare assignment. Some may choose to opt-out of Medicare entirely, meaning they do not accept Medicare payments and patients cannot seek reimbursement from Medicare for their services. This can lead to confusion and additional out-of-pocket costs because beneficiaries assume their concierge doctor accepts Medicare.

Don’t forget about excess charges, either. Medicare Part B excess charges are the additional fees a doctor or healthcare provider may charge over the Medicare-approved amount for services. These charges are not covered by Medicare (or the concierge care service) and must be paid out-of-pocket by the patient.

Misconception 5: Concierge care is available everywhere in the US

It is often assumed that concierge care is readily available throughout the United States, making it a viable option for anyone interested.

Concierge care practices are primarily concentrated in urban and suburban areas and are less common in rural regions. This limited availability can make it difficult for individuals in more remote areas to access concierge care. Additionally, even in areas where concierge care is available, the number of spots in each practice is often limited. That means not everyone who wants to join a concierge practice will be able to.

Concierge care is a viable but limited option for some

While concierge care can be a viable option for those with the cash, it is not a substitute for comprehensive health coverage for anybody needing more than a luxury primary care experience. The personalized attention and enhanced services provided by concierge care can indeed enhance the healthcare experience, but the substantial membership fees and limited coverage scope means that traditional health insurance, including Medicare, remains essential.

For those considering concierge care, it is vital to thoroughly understand what fees it covers, what additional costs may arise, and how this interacts with their insurance. By doing so, patients can make informed decisions about their healthcare and avoid unexpected financial burdens.

Largely, concierge care should be viewed as a complementary service that can enhance your healthcare experience. It should not be relied upon as a replacement for comprehensive health insurance coverage.