Concierge medicine and Medicare or insurance

What Medicare pays and what you pay

Concierge care under Medicare, per Medicare.gov

Item	Who pays	Rule
Membership fee	You	Medicare doesn't cover membership fees for concierge care. The amount depends on your contract with the doctor [1]
Covered services from a doctor who accepts assignment	Medicare, plus your usual cost sharing	The doctor can't charge extra, and the fee can't include extra charges for items Medicare usually covers [1]
Covered services from a doctor who doesn't accept assignment	Medicare, plus you	The doctor can charge more than the Medicare-approved amount, up to the 15% limiting charge [1]
Services Medicare doesn't cover	You	Any Medicare doctor can charge for them [1]
Non-covered items bundled into the fee	You	The doctor must give you an Advance Beneficiary Notice of Noncoverage (ABN) [1]

Fees vary widely. Three MDVIP physician pages we read listed $2,250, $2,400 and $2,930 a year ^[2][4][3], and MDVIP says members keep Medicare for care outside its Wellness Program ^[5]. Every published fee we found is in the Concierge Fee Index.

The Advance Beneficiary Notice

If a concierge membership fee pays for items or services Medicare won't cover, the doctor must give you a written Advance Beneficiary Notice of Noncoverage that lists them and says why Medicare may not pay ^[1]. Read it before you sign, check that it matches what the practice told you, and keep a copy.

Assignment, the limiting charge and opting out

Assignment means the doctor agrees to Medicare's approved amount for covered services. A doctor who accepts assignment can't charge you extra for those services ^[1]. A doctor enrolled in Medicare who doesn't accept assignment can charge up to 15% over the approved amount, the limiting charge ^[1].

Some doctors leave Medicare altogether. Medicare.gov's concierge care page does not mention doctors who have opted out or private contracts, and we could not read CMS's opt-out rules when we checked on October 17, 2026, so this page does not describe them. Ask any practice in writing: are you enrolled in Medicare, do you accept assignment, and have you opted out?

The Medicare annual wellness visit and a concierge physical

Medicare Part B covers a yearly “Wellness” visit if you are eligible, once every 12 months ^[7]. Your first one can't take place within 12 months of enrolling in Part B or of a “Welcome to Medicare” preventive visit, and you don't need a Welcome to Medicare visit to qualify ^[7].

You pay nothing for the visit if your provider accepts assignment, and the Part B deductible doesn't apply to it ^[7]. If extra tests or services are done during the same visit, you may owe coinsurance and the Part B deductible may apply. If Medicare doesn't cover those extra services, such as a routine physical exam, you may pay the full amount ^[7].

• The visit is a talk to build or update a prevention plan, with routine measurements and a review of your medical and family history and your prescriptions ^[7].
• It includes a written checklist of recommended screenings and vaccines, a cognitive assessment and a review of substance use risk, and you can discuss advance directives ^[7].
• Medicare.gov says it isn't a routine physical exam. Book a separate visit for a specific health concern ^[7].

A concierge annual assessment is a different thing. With a doctor who accepts assignment, the membership fee can't include extra charges for items or services Medicare usually covers ^[1]. So ask the practice whether it bills your yearly wellness visit to Medicare, which parts of its own assessment the fee pays for, and whether any physical exam it adds will be billed to you.

Private insurance and Medicare Advantage

Concierge practices keep billing insurance for covered care ^[6]. We found no source in our research saying commercial insurers pay the membership itself; MDVIP says its fee pays for screenings not typically covered by insurance ^[5]. We did not find Medicare Advantage rules for concierge fees in our research. Call your plan and ask whether the practice is in network and whether any part of the fee is reimbursed.

State rules

Medicare.gov says additional state laws and consumer protections may apply to concierge care, and it suggests contacting your state's insurance department or consumer protection bureau for more information ^[1].

Questions to ask before you sign

1. What is the yearly fee, and how can I pay it?
2. Do you accept Medicare assignment? Have you opted out of Medicare?
3. Which services does the fee cover, and will you give me an ABN for them?
4. Which visits and tests will you bill to Medicare?
5. How do I cancel, and is any part of the fee refunded?

For the bigger picture, see our concierge medicine guide, is concierge medicine worth it and concierge vs direct primary care. If you take a GLP-1 medicine, our GLP-1 Medicare coverage guide covers drug coverage separately.