What Is Concierge Medicine?
A plain-English guide to concierge medicine, direct primary care, and the membership-based primary care landscape — written by a board-certified internist running a small-panel concierge practice in Folsom & El Dorado Hills, CA.
Concierge Medicine, Defined
Concierge medicine is a primary care model in which patients pay a periodic membership fee — monthly, quarterly, or annual — for an enhanced relationship with a physician who deliberately limits panel size. A traditional primary care physician carries 2,000 to 3,000 patients. A concierge primary care physician typically carries 300 to 600. That single structural choice changes everything that follows: visit length, appointment availability, communication style, and the depth of clinical reasoning that any one patient receives.
The model is sometimes called “retainer medicine,” “boutique medicine,” “membership medicine,” or “subscription medicine” — these are the same thing under different marketing labels.
Concierge medicine emerged in the late 1990s as a response to declining physician satisfaction and shortening insurance-driven visit lengths. The first formalized concierge practices opened in Seattle in 1996, and the model has grown steadily since.
How Concierge Medicine Works
The mechanics vary by practice, but the core elements are consistent.
1. Membership fee
Patients pay a periodic fee to belong to the practice. The fee secures the relationship — guaranteed acceptance into the panel, defined access standards, and (depending on the practice) a specific set of included services.
2. Smaller panel
The practice deliberately caps the number of patients per physician. Typical caps are 300 to 600. Some premium concierge practices cap at 100 to 200. The cap is the structural mechanism that makes everything else possible.
3. Defined access standards
Most concierge practices commit to specific access standards: same- or next-day appointment availability, direct physician phone or text contact, response within defined time windows. These commitments are concrete because the panel size makes them deliverable.
4. Insurance handling varies
Three patterns exist:
- Direct primary care (DPC). Practice does not bill insurance for membership-included services. Patient pays the flat monthly fee. Insurance still covers other care (specialists, hospital, imaging, etc.).
- Hybrid concierge. Practice bills insurance for clinically covered services AND charges a membership fee for additional non-covered services. This is the most common model and requires careful structure to remain compliant with Medicare assignment rules.
- Insurance opt-out concierge. Practice opts out of Medicare and (sometimes) commercial insurance entirely and charges a higher membership fee that includes all primary care.
5. Continuity
Patients see the same physician every visit. Care plans build across visits rather than restarting.
Concierge Medicine vs Traditional Primary Care
The differences are largely a function of panel size.
| Feature | Traditional Primary Care | Concierge Medicine |
|---|---|---|
| Panel size | 2,000–3,000 patients | 300–600 patients |
| Visit length | 15–20 minutes | 30–60+ minutes |
| Wait for routine appointment | 2–6 weeks | Same- or next-day |
| Direct physician access | Through portal/staff | Direct phone, text, or email |
| Annual physical depth | ~30 minutes, basic labs | 60–120 minutes, comprehensive labs |
| Continuity of physician | Variable — system-driven | High — same physician every visit |
| Cost beyond insurance | Insurance copays / deductibles | $1,800–$25,000+ annual membership |
Concierge medicine is not for everyone. Patients who rarely interact with their doctor and have stable, simple care needs may find traditional primary care sufficient. The model is most valuable for adults managing chronic conditions, juggling specialists, navigating mid-life health complexity, or simply wanting a physician who has time to think.
Concierge Medicine vs Direct Primary Care (DPC)
Direct Primary Care (DPC) is a specific subset of concierge medicine — but the labels are often used interchangeably, which causes confusion.
The defining feature of DPC: the practice does not bill insurance for primary care services. Patients pay a flat monthly membership ($100–$200/month is typical), and that fee covers all primary care visits, basic labs, and care coordination. Insurance is still recommended for catastrophic events, hospitalization, surgery, and specialty care.
Concierge medicine, more broadly, includes hybrid models in which the practice bills insurance for some services and charges a membership for additional services. This is the most common concierge model in the United States.
Side-by-side
| Feature | DPC | Hybrid Concierge |
|---|---|---|
| Insurance billed for primary care | No | Yes (for covered services) |
| Typical monthly fee | $100–$200/month | $200–$2,000+/month |
| HSA/FSA eligible | Yes (DPC fees) | Varies by what's billed |
| Ideal for | Adults under 65 wanting transparent, simpler primary care | Adults wanting concierge-level care plus insurance billing for covered services (especially Medicare patients) |
| Compliance complexity | Lower | Higher (especially with Medicare patients) |
MDVIP, Forward Health, One Medical & Other Concierge Alternatives
The concierge / membership primary care landscape includes both national chains and independent local practices. A short tour:
MDVIP
MDVIP is the largest national concierge network — approximately 1,400 affiliated physicians serving 425,000 members across the United States. Annual fees typically range from $1,800 to $2,500. Members receive a comprehensive annual physical (the “Wellness Program”), smaller panels (around 600 patients per physician), and direct physician access. MDVIP physicians remain in-network with most insurance plans for clinical visits beyond the annual physical.
Strengths: National brand, established infrastructure, in-network with most insurance, well-developed annual physical.
Trade-offs: Panels are larger than dedicated independent concierge practices; standardization across affiliated physicians is variable; no longevity-medicine specialization.
Forward Health
Forward Health was a venture-backed primary care subscription operating approximately 2018 to 2024. It charged $149/month and emphasized in-clinic technology, app-based scheduling, and concierge-like access. Forward shut down in late 2024. Former Forward members have transitioned to direct primary care, independent concierge practices, or returned to traditional insurance-based primary care.
One Medical (Amazon)
One Medical, now owned by Amazon, is a tech-enabled primary care chain charging approximately $200 to $250 annually in addition to insurance. The company emphasizes same-day appointments and a polished mobile app. However, panels at One Medical are typically 1,500 to 2,000 patients per physician — closer to traditional primary care than to concierge medicine.
Function Health
Function Health is a direct-to-consumer testing service (~$499/year) that runs a panel of 100+ biomarkers and provides results with limited physician interpretation. It is not a primary care practice and does not provide medical care, prescriptions, or continuity. Many concierge longevity practices integrate Function-style testing while providing the actual physician interpretation and ongoing care.
Independent Local Concierge / DPC
Independent practices like ours offer smaller panels, direct relationships with the practice owner, and the ability to specialize (longevity medicine, executive health, hormonal optimization, GLP-1 weight management) in ways national chains generally don’t.
How Much Does Concierge Medicine Cost?
Pricing varies widely. A rough framework:
| Tier | Typical Annual Cost | What's Included |
|---|---|---|
| Direct Primary Care | $1,200–$2,400 | All primary care; basic labs at cost |
| Mid-tier Concierge (MDVIP-style) | $1,800–$4,000 | Annual comprehensive physical, smaller panel, direct access; insurance still bills for covered care |
| Premium Concierge / Longevity | $3,500–$10,000 | Smaller panels, longevity testing interpretation, advanced screening, executive physical |
| Ultra-premium Concierge | $15,000–$50,000+ | 100-patient panels, near-24/7 access, full opt-out from insurance |
Private MD's Direct Primary Care is $149/month ($1,788/year) for adults under 55 — the lower end of DPC. The Longevity Internal Medicine Program is $299/month ($3,588/year) for adults 55+ or as an add-on at any age, with the membership fee allocated exclusively to non-covered longevity services.
Concierge Medicine for Medicare Patients
Concierge medicine for Medicare-enrolled patients requires careful structure. Medicare assignment rules — the rules participating physicians agree to when accepting Medicare — prohibit charging Medicare patients additional fees for services Medicare should be covering. The 2004 OIG Bulletin and the Fanelli case (2007) established that membership fees paid by Medicare patients must be allocated only to genuinely non-covered services.
Compliant hybrid concierge practices structure this carefully:
- Medicare is billed normally for all covered clinical services — visits, preventive care, chronic disease management, Medicare-covered labs.
- The membership fee is allocated exclusively to non-covered services — longevity testing interpretation, advanced screening guidance, comprehensive longevity panels, personalized health planning.
- The membership fee does not modify, reduce, or waive any Medicare benefit or cost-sharing obligation.
This is the architecture of our Longevity Internal Medicine Program. See our FAQ for more detail on how the structure works.
How to Evaluate a Concierge Practice
Questions worth asking before enrolling in any concierge or DPC practice:
- Panel size cap. A real concierge practice should have a defined cap. 300–600 is typical.
- What's included vs billed separately. Especially for hybrid concierge — what services does the membership cover, and what is billed to insurance?
- Medicare handling. If you're approaching or already on Medicare, ask specifically how Medicare patients are handled.
- Physician training and tenure. Board certification, training program, years in practice.
- Advanced testing. If longevity-focused, what specific testing is offered or interpreted? Is it integrated into care or sold separately?
- Communication standards. What are the response time commitments? Who responds — the physician, a nurse, a portal team?
- Cancellation terms. How long is the contract? What's the cancellation policy?
- Meet-and-greet. Does the practice offer a no-obligation introductory call before enrollment? Most should.
Is Concierge Medicine Right for You?
Concierge medicine is most valuable for:
- Adults managing one or more chronic conditions (hypertension, diabetes, hyperlipidemia, hormone issues) where attentive longitudinal management makes a difference.
- Adults navigating mid-life health complexity — the years where things start changing and need integration across specialists.
- Adults 55+ wanting the additional preventive depth of longevity-focused medicine.
- Busy professionals where a 2–6 week wait for an appointment is genuinely costly.
- Adults who want a primary care physician who has time to think about their case.
- Couples wanting consistent care for both partners under a single physician.
Concierge medicine may not be the best fit for:
- Adults with no chronic conditions who rarely interact with the medical system.
- Adults preferring a large insurance-based health system with extensive ancillary services.
- Patients seeking high-volume traditional primary care without a membership commitment.
If This Sounds Like What You're Looking For
Private MD is a small-panel, board-certified internal medicine practice serving Folsom, El Dorado Hills, Granite Bay, Roseville, Sacramento, and the surrounding area. We offer Direct Primary Care for adults under 55 ($149/mo) and a Longevity Internal Medicine Program for adults 55+ or as an add-on at any age ($299/mo).
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Founder Nishant Sahni, MD — board-certified internist; former Mayo Clinic and University of Minnesota faculty.