Concierge care
Medicare doesn't cover membership fees for concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care).
Your costs in Original Medicare
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.
What it is
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.
Things to know
Doctors who offer concierge care must still follow all Medicare rules, including the following:
- Doctors who accept assignmentcan’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.
Assignment
An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. - Doctors who don’t accept assignment can charge you more than the Medicare-Approved Amountfor Medicare-covered services, but there’s a 15% limit called the "
Medicare-approved amount
The payment amount that Original Medicare sets for a covered service or item. When your provider accepts assignment, Medicare pays its share and you pay your share of that amount.limiting charge."Limiting charge
In Original Medicare, the highest amount of money you can be charged for a covered service by doctors and other health care suppliers who don't accept assignment. The limiting charge is 15% over Medicare's approved amount. The limiting charge only applies to certain services and doesn't apply to supplies or equipment. - All Medicare doctors (whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover.