Physicians play a significant role in seniors’ lives. Most older adults need more care as their likelihood of developing chronic and other medical conditions increases. They also need more physician guidance and consultation time. Yet, this is often lacking as physicians strive to serve more patients with limited time.
Seniors and adults of all ages are instead increasingly looking to an emerging model of health care called “concierge medicine,” also known as direct primary care or subscription-based care. This model offers patients benefits like personalized care, same-day appointments and round-the-clock physician access in exchange for a monthly or quarterly upfront fee.
This model offers patients benefits like personalized care, same-day appointments and round-the-clock physician access in exchange for a monthly or quarterly upfront fee.
“Today’s traditional model of primary care is highly volume-driven, where physicians often see 2,500 or more patients,” said Lawrence Gassner, MD, a Phoenix-based internist with MDVIP, a national concierge practice. “In a traditional practice it can be difficult to even get an appointment. And because doctors see an average of 20 or more patients a day, visits are often rushed.”
The concierge model began in 1996, when MD2,, a national health network, offered exclusive services to the tune of some $25,000 annually, boasting 24/7 access and more to those who could afford it.
Most subscription prices are lower these days, but concierge medicine is still skewed toward high-income people. According to a 2020 income inequality report by NPR, more than one in five adults in the top 1% income level say they participate in concierge medicine. Fewer than one in 10 low- and middle-income adults say the same.
However, concierge medicine is evolving to become more affordable and more common, offering several different variations and costs—along with their own pros and cons.
…concierge medicine is evolving to become more affordable and more common, offering several different variations and costs—along with their own pros and cons.
Prevalence of concierge medicine, direct primary care
Tracking the number of concierge practices is difficult because it’s a business model, not a specialty, and there’s no official registry for these types of physician practices. However, Concierge Medicine Today LLC estimates between 10,000 and 25,000 U.S. concierge or subscription-based models exist in 2022.
Another difficulty in tracking comes with new variations like direct primary care. The model is often used interchangeably with concierge care, but according to a 2021 Scientific American article, there’s a difference in price and services.
Concierge practices typically offer advanced health screenings usually not covered by insurance in exchange for pricy subscription fees. They also accept insurance for other services. Concierge doctors’ specialties vary, although Concierge Medicine Today reports family medicine (32%) among the top five.
Conversely, direct primary care practices focus solely on primary care, including office visits, lab work and some additional services—and do not accept insurance. Instead, they charge a subscription fee that’s typically more affordable than concierge fees in exchange for personalized, comprehensive primary care.
Concierge medicine costs
Just how expensive is concierge health care? Prices start at $1,500 to $2,400 annually, or $125 to $200 monthly but can go up to $20,000 annually for more specialized services. That’s a wide range because it often depends on the included services.
MDVIP, for example, charges $1,650 to $2,200 annually, depending on location. Gassner said that, in addition to shorter wait times, longer visits and more personalized care, MDVIP patients receive a comprehensive annual exam that includes, “advanced screenings and diagnostic tests to provide a clearer view of their health and risk for conditions like diabetes and heart disease.” These tests, he said, are typically not covered by insurance.
Gassner also accepts Medicare and other forms of insurance to cover sick visits and other services.
Pros and cons of concierge medicine
The benefits of concierge medicine include shorter wait times for visits and procedures, more personal physician relationships and more time with doctors. Concierge care may also save older adults money in the long run if they need frequent visits or procedures that are covered by the retainer fee.
One advantage many practices claim is better health outcomes: MDVIP reports its advanced screenings identify 40% more patients at risk for cardiovascular issues and its patients experience 70% fewer hospitalizations versus those in traditional primary care.
The more personal relationship developed over time may also boost medical outcomes, as studies suggest seniors with conditions like dementia benefit from sticking with the same doctor.
The biggest disadvantage is the cost. In addition to the subscription fee, concierge patients still need commercial insurance for prescriptions, specialist visits, surgeries and other care. And while concierge practices vary widely, there are almost always services – whether planned or unplanned – that aren’t covered under the upfront fee.
Also, because concierge and direct primary care practices deliberately limit their numbers of patients, it can be difficult to find a concierge physician, and the cost can be prohibitive for many.
Making an educated decision on concierge medicine
When considering a concierge practice, keep some points in mind:
- Find out what’s covered and understand the fees. Concierge and direct primary care practices vary widely, so find out what’s covered under the fee. Do your best to estimate what you might pay in copays without the fee, and compare costs. Also, make sure you understand the time commitment for the fee and what happens if you end your membership.
- Know your physician. As with any doctor, make sure you’re comfortable with who’s treating you. Conduct interviews, and make sure the person you interview will be your main contact, versus a nurse or physician assistant. Also, inquire about the physician’s specialties and training.
- Take advantage of tax breaks. Track your expenses, as fees and other health care costs may be tax-deductible. Consider setting up a health savings account or flexible spending account, so you can use pretax income to pay health costs.
- Seek specialist care when necessary. According to a 2019 AARP article, patients sometimes become so comfortable with their concierge physicians that they don’t seek out specialists when necessary. It’s important to understand certain conditions might require care beyond your doctor’s training.