Concierge care
Medicare doesn't cover membership fees for concierge care
Description
Concierge care is when a doctor or group of doctors charges you a membership fee before they’ll see you or accept you into their practice. After you pay the membership fee, you may get some services or amenities that Medicare doesn’t cover. Concierge care is also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care.
Coverage details
Doctors who offer concierge care must still follow all Medicare rules, including the following:
- Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means your membership fee can’t include additional charges for items or services that Medicare usually covers, unless Medicare won’t pay for the item or service. In this situation, your doctor must give you a written notice called an "Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons why Medicare may not pay.
- Doctors who don’t accept assignment can charge you more than the Medicare-approved amount for Medicare-covered services, but there’s a 15% limit called the "limiting charge."
- All Medicare doctors (whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover.
Costs
You pay 100% of the membership fee for concierge care.
Note: Your membership fee depends on the contract or agreement you sign with the doctor or doctor group. Additional state laws and consumer protections may apply. For more information, contact your state’s insurance department or consumer protection bureau.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service