Is Concierge Medicine Worth the Cost?

by Jessica Sommerfield · 8 comments

doctors
Concierge medicine is a fringe healthcare concept that’s been around since the 90s, but lately it’s been gaining momentum. The American Academy of Private Physicians reports there are still under 5,000 practices in the United States, but surveys show a growing number of physicians — especially the younger generation — are becoming interested in this type of practice model.

So how does it work? Basically, it’s a private form of care (similar to direct care) in which physicians charge their patients an out-of-pocket retainer fee in exchange for full, immediate access to their services. Physicians who operate under this structure maintain a much smaller pool of clients, ranging from 500 to 1,000 versus several thousand in a traditional practice.

The unpopularity of this type of care is based on the perception that it only benefits physicians and wealthy patrons, but the rising cost of health care is starting to level the difference between concierge plans and Obamacare or private insurance, making it appealing to a larger group of consumers. For instance, physicians in one of the larger concierge networks charge an annual retainer fee ranging from $1650 to $1800 a year; in contrast, an average Obamacare plan costs thousands more. For some, the upfront cost difference is enough to give it a second glance.

But is it worth it for you? Here’s a rundown of both the good and bad so you can decide for yourself.

Advantages of Concierge Medicine

Essentially, concierge medicine differs from traditional care in that it is not sick care, but preventative care. One of the greatest advantages of concierge models is more personal care. Because physicians have fewer patients, they can devote more time to the ones they have. A smaller workload can also mean faster diagnoses and treatment for life-threatening conditions. Many deliver same or next-day appointments, longer appointment time, in-home visits, fast emergency care, and preventative screenings and tests not offered by most insurance plans.

If your physician is part of a network such as the MDVIP, you may even be able to see another network physician if you have an emergency while away from home.

As for expenses not covered by the retainer fee, many concierge models and networks coordinate with insurance providers or Medicaid. Out-of-pocket expenses (excluding your retainer fees) may also qualify for flex-spending reimbursement from your regular insurance provider.

The Downside of Concierge

On the other hand, concierge medicine still represents an out-of-pocket medical expense many people cannot afford, especially since most still need insurance to pay for whatever the retainer fee doesn’t cover (Obamacare and other insurance providers cover many procedures that a concierge membership does not). Otherwise, you’re paying even more out-of-pocket. Unless your insurance is free, that’s a monthly/yearly retainer fee plus your insurance premium.

Secondly, retainer fees are not covered by insurance, and some companies even refuse to work with physicians who collect retainer fees, mostly because they believe it fosters inequality. In other words, you may have difficulty reconciling your insurance with your preference for a concierge-platform physician.

Lastly, retainer fees vary widely and tend to be higher in more expensive areas. If you live in one of these areas, the fees for a concierge physician may be higher than you can afford.

What Do You Think?

In spite of the potential problems with concierge medicine, it still might be the right option for you. Can you afford it, or is actually cheaper than your other insurance options? It might be something to think about. You may also be willing to pay a little extra if fast, personal and preventative care is very important to you and your health situation — some people especially value being able to call, e-mail, or even text their physician directly. If you think you might be interested in concierge medicine, check out the locator tool provided by the  American Academy of Private Physicians to see if there are any physicians or networks near you.

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{ 8 comments… read them below or add one }

Latoya @ Femme Frugality March 4, 2016 at 7:43 am

I’ ve never heard of concierge medical services. It’s not something to rule out for anyone though if it saves them money in the long run. May be worth looking into. Thanks for sharing!

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David Ning March 4, 2016 at 8:47 am

You’re welcome Latoya.

Hiring concierge doctors isn’t common, but the move can definitely be a lifesaver if you happen to need prompt attention. The other advantage is that since you are likely to see the same doctor for years, he/she will know your medical history and can work with other specialist to give you a more suitable medical treatment in times of need.

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Derek @ MoneyAhoy March 4, 2016 at 5:21 pm

I think this is an awesome idea and a great way to get more money into the hands of those that deserve it (doctors) and out of the hands of those that don’t (insurance companies). This could really help to lower healthcare costs for most folks if it catches on!

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David Ning March 5, 2016 at 4:04 pm

Right on Derek.

The more efficient we can make our health care system, the better everyone will be!

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Dave @ Financial Slacker March 5, 2016 at 1:22 pm

I have had a concierge medicine plan for the past year. I pay an annual fee to have access to a private physician through secure email, phone calls, and next day appointments.

Office visits are billed through my insurance similar to any other provider. I pay the co-pay or out-of-pocket until my deductible is met. Plus, the provider may be considered out-of-network by your insurance in which case, you will be paying higher fees and a higher deductible must be met. So it’s definitely not lower cost. If anything, it’s the same or more plus the concierge fee.

I am struggling with whether to continue the plan as I only accessed my physician on a few occasions. My health is good, but if I had issues, it would definitely be worth it.

One of the unwritten benefits is your concierge physician getting you a quick appointment with a specialist. Normally, it might take a few weeks or even months to get in with a certain specialist. In my experience, a concierge physician can shorten that wait considerably. But again, this is only a benefit if you have the health need.

It’s comforting to have a physician available whenever needed, but it definitely comes with a cost.

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David Ning March 5, 2016 at 4:08 pm

See the payment as insurance if you decide to continue, then be glad that you don’t need to use the coverage because that means you are healthy!

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kim March 6, 2016 at 5:35 pm

I am a huge proponent of preventative care – so this in some ways appeals to me. If you are going to spend money somewhere I believe healthcare would be the way to go. I still find it frustrating that there is not more preventative care available in our current system. When was the last time anyone talked to you about diet and chiropractic when you saw the doc?

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David Ning March 7, 2016 at 4:40 pm

We can only hope that one day someone will come up with a better model where the doctors are compensated by quality of care rather than quantity of care. Otherwise I’m afraid many will only do as much as what will get patients out of the door.

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