If you're over 65, Medicare covers hospital stays, doctor visits, lab work, and most of the core of healthcare. For most seniors, the real gaps aren't about what's covered. They're about how the covered care is delivered: how long the wait is, how much time you get with the doctor, whether anyone knows your full medical story, and whether someone is actually available when you need them.
This is the gap concierge medicine is designed to fill, not as a replacement for Medicare but as a layer on top of it.
TL;DR
- Membership fee: NOT covered by Medicare. Medicare never pays the annual or monthly retainer.
- Medical visits, labs, vaccines, screenings: COVERED, if your concierge physician participates in Medicare. These are billed to Medicare exactly as at any other practice.
- Medicare Advantage: same rule. Plans cover the medical services, not the membership.
- Medigap (Supplement) plans: cover the 20% Part B coinsurance after Medicare pays.
- HSA/FSA: the membership fee itself is generally not eligible.
- Tax: the membership may be deductible as a medical expense if it exceeds 7.5% of AGI.
- To reach the practice: call or text 561-468-6981.
How Medicare and concierge medicine actually work together
The cleanest way to think about it: Medicare is the insurance, the concierge membership is the access. Two separate transactions.
When you see your concierge doctor for a visit that would otherwise be a covered Medicare service (annual wellness visit, sick visit, chronic-disease check, routine lab), the doctor bills Medicare using the same CPT codes any other PCP would. Medicare pays its 80% of the allowed amount; your Medigap plan picks up the 20%. The membership fee is a separate charge for things Medicare has never covered: same-day access, 30 to 60 minute appointments, after-hours phone and text, care coordination, and house calls.
CMS has addressed this directly. In OIG Alert 04-04, the agency clarified that a concierge fee is permissible as long as the membership doesn't bill Medicare for services Medicare already covers. Reputable practices are careful about this line.
What Medicare doesn't pay for (and concierge does)
Medicare covers what happens to you medically. It doesn't cover how that care gets delivered. Specifically:
- Same-day appointments. Medicare reimburses the visit; it doesn't solve the three-week wait to get one.
- Extended visit time. Your doctor gets paid roughly the same whether they spend 7 minutes or 45 minutes with you, and the math pushes practices toward shorter visits.
- After-hours access. Medicare doesn't pay your doctor to answer your call at 9 p.m.
- House calls. Largely eliminated from traditional practice because the economics don't work under Medicare's reimbursement structure.
- Care coordination. Medicare doesn't reimburse the time your doctor spends on the phone with your cardiologist, reviewing your specialist reports, or tracking what got ordered.
- Real preventive work. Medicare covers an annual wellness visit, but your doctor still has 2,500 other patients and 15 minutes to do it in.
In a concierge practice with a 50-patient panel, those gaps close structurally. Same-day or next-day visits when something feels wrong. (How same-day house calls work in this practice.) 60 to 90 minute annual physicals with thorough labs and risk calibration. (What to expect from an executive-level physical.) Direct cell phone access for non-emergencies day or night. (What it's actually like to have a doctor available 24/7.) House calls included in the membership.
The two situations to know about
There are essentially two ways a concierge doctor can be set up relative to Medicare:
- Medicare-participating concierge physician. The vast majority. Bills Medicare for covered services. You pay the membership fee separately, and your medical care is processed through Medicare and your supplement just like at a non-concierge office. This is what most patients want.
- Non-participating or opted-out physician. A smaller subset. The doctor has formally opted out of Medicare and bills patients directly via private contracts. Medicare reimburses nothing. Used most often by direct primary care (DPC) practices, which is structurally different from concierge medicine.
If you have Medicare, always ask before joining: "Do you participate in Medicare?" A "yes" means your medical services are covered; a "no" means you'll pay out of pocket for visits in addition to the membership.
Medicare coverage at a traditional vs. concierge practice
| Service / Feature | Traditional Medicare PCP | Concierge (Medicare-participating) |
|---|---|---|
| Annual wellness visit | Covered by Part B | Covered by Part B |
| Office visit (sick or chronic) | Covered by Part B | Covered by Part B |
| Preventive screenings | Covered by Part B | Covered by Part B |
| Vaccines | Covered by Part B/D | Covered by Part B/D |
| Routine labs ordered by PCP | Covered by Part B | Covered by Part B |
| Membership / retainer fee | N/A | NOT covered, patient pays out of pocket |
| Same-day/next-day appointments | Not guaranteed | Included in membership |
| Visit length | ~7 to 15 minutes | 30 to 60 minutes |
| 24/7 physician access | No | Included in membership |
| House calls | Rarely available | Included or available |
| Care coordination | Limited | Included |
| Medigap/Supplement applies? | Yes, to covered services | Yes, to covered services |
| HSA-eligible (membership)? | N/A | Generally no |
Medicare Advantage and concierge medicine
Medicare Advantage (Part C) follows the same logic: the plan covers the medical services your concierge doctor provides if that doctor is in-network, and the membership fee remains your separate responsibility. A few wrinkles:
- Network restrictions. Advantage uses HMO/PPO networks. If your concierge doctor isn't contracted with your specific Advantage plan, your medical visits won't be covered or will be paid at out-of-network rates. Patients who want maximum concierge flexibility tend to stay on Original Medicare plus a Medigap plan.
- Prior authorization. Advantage plans deny a meaningful share of prior-auth requests. A concierge doctor with time to fight on your behalf is meaningful here.
- "Extra benefits" don't include concierge fees. Advantage plans market $0 premiums and "extras" like gym memberships and OTC allowances. None reimburse concierge membership dues.
Medigap and out-of-pocket math
If you have Original Medicare plus a Medigap (Plan G or Plan N are the most common), your out-of-pocket exposure for medical services at a concierge practice is essentially the same as at any other practice: Part B pays 80% of the allowed amount after the annual deductible, Medigap picks up the rest.
The membership is the additive cost. The question to ask yourself: does the additional access, time, and continuity justify the membership on top of the Medicare structure I already pay for?
For some patients (those with multiple chronic conditions, those who travel for half the year, those caring for aging family members at a distance) the answer is clearly yes. For a healthy 67-year-old with one PCP visit a year and a flu shot, it's probably no.
Tax, HSA, and FSA treatment
A concierge membership can be a deductible medical expense under IRS Publication 502 to the extent it pays for medical care, but only when total medical costs exceed 7.5% of AGI. Most retirees take the standard deduction post-2017 reform and don't benefit.
The IRS generally views concierge retainers as pre-paid medical care, which is not a qualified HSA/FSA expense at the moment of payment. A narrow exception exists when service-by-service medical work is documented separately. Confirm with your tax advisor before assuming reimbursement.
Where concierge plus Medicare especially helps
Three patient profiles where the math most often justifies the membership:
1. Snowbirds and seasonal residents
Patients splitting time between Florida and a northern state often struggle with Medicare Advantage networks and with finding a primary care doctor in their seasonal location. A Medicare-participating concierge doctor in Florida who travels with you (via telehealth) provides one consistent medical home.
2. Multiple chronic conditions
Medicare patients managing diabetes, atrial fibrillation, COPD, heart failure, or kidney disease typically see 5 to 10 specialists annually. A PCP who quarterbacks the imaging, the specialist calls, and the medication reconciliation prevents avoidable admissions.
3. Adult children of aging parents
If you live in another state and your parents are in Florida, having a concierge doctor as the medical point person changes everything. The doctor can be reached. They know the parent's history. They call you when something changes.
Medication review (a senior-specific gain)
Seniors often carry 5 to 10 or more medications prescribed by multiple specialists. In a 7-minute traditional visit there's no time to review the full picture, check for interactions, or look for ways to simplify. In a concierge visit there is. Polypharmacy is a common source of harm; an attentive physician can usually reduce the pill burden while improving outcomes.
What to ask before joining a concierge practice on Medicare
Get written answers to these:
- Do you participate in Medicare (accept assignment)? The single most important question.
- Will you bill Medicare for visits, labs, and procedures? Should be yes for any covered service.
- What exactly does the membership fee cover? Get the list in writing.
- Do you charge separate fees for any Medicare-covered services? Honest answer should be no, anything else is a red flag.
- How does my Medigap or Advantage plan interact with this practice? Confirm in-network status for Advantage.
- What happens if I drop the membership mid-year?
- Any extra fees for after-hours calls, house calls, or hospital visits? Should be included.
Frequently Asked Questions
Does Medicare cover the cost of joining a concierge medicine practice?
No. Medicare never pays the membership fee, retainer, or annual dues. It only pays for covered medical services (visits, labs, screenings, vaccines) provided by a Medicare-participating physician. The membership covers extras Medicare has never covered: 24/7 access, longer visits, house calls, and coordination.
Do concierge doctors take Medicare?
Most do. The vast majority of concierge primary care physicians participate in Medicare and bill it for covered services exactly as a traditional practice would. A smaller subset (often direct primary care practices) opt out. Always ask "Do you participate in Medicare?" before signing up.
How does concierge medicine work with Medicare in practice?
You pay the concierge membership separately. Your medical care is billed to Medicare in the standard way for covered services (E&M codes, labs, vaccines, etc.). Medigap pays the 20% coinsurance after Medicare. The membership covers the access and time Medicare never reimbursed: same-day visits, 30 to 60 minute appointments, direct cell access, care coordination, and house calls.
Can I use my Medigap or Medicare Supplement plan at a concierge practice?
Yes. Medigap pays the 20% coinsurance and deductibles for Part B-covered services as long as the doctor participates in Medicare. Medigap does not cover the concierge membership fee.
Does Medicare Advantage cover concierge medicine?
Advantage covers your medical services if your concierge doctor is in-network, with the same copays as any other in-network provider. The membership fee is not covered. Patients who want maximum flexibility with concierge care tend to stay on Original Medicare with a Medigap plan.
Is the concierge membership fee tax deductible?
Possibly. The IRS allows medical expenses to be deducted on Schedule A only to the extent they exceed 7.5% of AGI. A concierge membership may qualify if it can be characterized as payment for medical care. Most retirees take the standard deduction and do not benefit.
Can I pay the concierge membership fee with my HSA or FSA?
Generally no. IRS guidance treats periodic concierge retainers as pre-paid medical care, which is not a qualified medical expense at the moment of payment. A narrow exception applies when services are itemized and documented separately. Confirm with your tax advisor.
What happens if my concierge doctor opts out of Medicare?
Medicare pays nothing and your Medigap plan will not help either (it only pays after Medicare does). You will pay the doctor directly under a private contract. This is more common in direct primary care than in concierge medicine. Confirm status before joining.
Are concierge medicine annual physicals covered by Medicare?
The Medicare Annual Wellness Visit (codes G0438/G0439) is covered by Part B with no copay at any participating practice, including concierge ones. Concierge practices often add supplemental labs and screenings that go beyond the Medicare definition; the extra work is part of what your membership pays for.
How do I find a concierge doctor who takes Medicare in my area?
Ask directly, get the answer in writing, and verify on Medicare.gov's Care Compare tool. In Boca Raton and the Palm Beaches, contact this practice at 561-468-6981 to confirm Medicare-participating status.
Will my concierge doctor coordinate with my Medicare specialists?
Yes. Medicare-participating concierge physicians coordinate with specialists, hospitals, home health, and pharmacies the same way any PCP does, except with more time available. This coordination is one of the most-valued and least-marketed parts of the membership.
How to evaluate any concierge practice for Medicare-friendliness
The right concierge doctor isn't necessarily the most expensive or the most heavily marketed. It's the one with a small enough panel to actually give you time, who participates in Medicare for covered services, who answers when you call, and who is transparent about what the membership covers versus what gets billed to Medicare. (Full evaluation criteria here.)
About the Author
Dr. Ben Soffer, DO is a board-certified physician practicing concierge primary care in Boca Raton, Florida. He participates in Medicare for covered medical services and structures the concierge membership for the access, time, and continuity Medicare alone can't deliver in 2026.
Talk through whether it fits your Medicare situation
A no-obligation conversation about whether this practice makes sense alongside your existing Medicare coverage.
- Call: 561-468-6981
- Email: info@drbensoffer.com
- Or reach out through the contact form
Serving Boca Raton, Palm Beach County, and the surrounding area.
