Does Medicare cowl concierge drugs?

“Concierge medicine is when people pay an annual membership fee for a more personalized approach to their health care,” says Bret Jorgensen, CEO of MDVIP, the largest network of concierge providers, with over 1,100 affiliated primary care physicians.

Given the rise in chronic diseases and the rapid growth in the older adult population, there’s an increased need for healthcare services. As a result, the global concierge medicine market is booming, with North America leading the way.

While there is no national registry of physicians using a concierge model, one industry publication estimates there are between 12,000 and 13,000 physicians in the U.S. offering a subscription-based medical program.

That’s a drop in the bucket compared to the over 500,000 primary care physicians in the U.S., but the number of concierge physicians is growing at a rate of 3% to 5% annually.

Concierge medicine: A growing option for older patients

“Most of our members are aged 50 to 80, and are more focused on their health trajectory,” says Jorgensen. “They want to get a more personalized relationship with their doctor and delay or avoid chronic illnesses, or manage them better.”

All of MDVIP’s concierge physicians accept Medicare, and over half of its 400,000 members are on Medicare. 

How much does a concierge membership cost?

The average cost of an annual concierge membership ranges from $2,000 to $5,000 per year. This allows concierge doctors to serve a smaller number of patients, generally ranging from 400 to 600, compared with 2,000-3,000 in a traditional primary care practice.

What services are included in a concierge membership?

According to Jorgensen, the membership fee typically covers:

• Same-day or next-day appointments (in person or virtually)
• Same-day answers to questions
• Longer visits, sometimes 30 minutes or more
• Annual personalized wellness plans

Some concierge medicine doctors also include these benefits as part of the membership fee:

• Direct access to your concierge physician, by email and phone
• Enhanced blood work
• The ability to visit other in-network concierge doctors while traveling
• Coverage of young adults in the household

What Medicare covers

Just like any medical provider, concierge doctors may or may not choose to accept insurance, including Medicare.

“If a concierge doctor accepts Medicare, then the doctor must accept the Medicare-approvedcharge for all covered services to Medicare patients,”  says Diane Omdahl, author of Medicare for You and cofounder of the Medicare advisory firm 65 Incorporated. Medicare deductibles and co-pays will also apply.

Typical services covered under Medicare include blood tests associated with a diagnosis, MRIs and x-rays, and same-day surgery, says Omdahl.

“Membership fees charged by concierge doctors are not covered by either Medicare or Medicare Advantage,” says Omdahl.

If the doctors have contracts with Medicare Advantage plans, services and payments are based on the plans’ coverage criteria, deductibles, and co-pays, says Omdahl.