Every February or March someone in my practice asks me to write a letter for their CPA explaining what the membership fee covers. The CPAs already know what concierge medicine is. They want the letter for the same reason a hospital bill gets itemized: documentation in case of audit. The letter is reasonable to ask for. The deduction itself is reasonable to take. But it's worth understanding the framework before you assume it'll save you taxes.
Schedule A in one paragraph
If you itemize deductions on your federal tax return instead of taking the standard deduction, Schedule A is where you list things like mortgage interest, state and local taxes, charitable giving, and medical expenses. Medical expenses are the line we care about here. Specifically, you can deduct the portion of your medical expenses that exceeds 7.5% of your adjusted gross income.
That second part matters. If your AGI is $200,000, your 7.5% floor is $15,000. Only medical expenses above $15,000 deduct. If your medical expenses are $14,000, you deduct zero. If they're $25,000, you deduct $10,000.
For most households, the floor never gets cleared. For some households, especially retirees with chronic conditions, snowbirds with two-state medical setups, or anyone with a serious medical year, it clears easily. That's the population concierge medicine economically makes sense for, and it's the population the Schedule A deduction actually helps.
Yes, concierge medicine counts
The IRS rules for what qualifies as a medical expense are in Publication 502. The list is long and explicit. Doctor fees count. Hospital fees count. Lab and imaging count. Prescription medications count. Insurance premiums count, mostly. Long-term care premiums count, partially.
Concierge medicine fees fall under "fees you pay to a doctor." There's no special carve-out, no asterisk, no need for the fee to be tied to a specific service. The IRS has consistently treated concierge memberships as medical expenses on Schedule A.
Why is this different from the HSA/FSA treatment? Because Section 213(d) which governs Schedule A is broader than what HSA administrators look at. Schedule A includes anything paid for medical care, which the IRS interprets to include the relationship itself. HSAs have historically applied a stricter "specific service" test. Same root statute, different operational interpretation. I wrote about that side here.
What to document
The letter from the practice is helpful but not strictly required. What the IRS actually wants, if you ever get audited, is proof that you paid the expense and that it was for medical care. A receipt showing payment to the practice, plus an annual statement from the practice describing what the membership covers, is more than enough.
If you want one for your records, ask. Most concierge practices, mine included, will provide a year-end summary letter on request. It usually says something like "Patient X paid $Y to this practice in tax year 20ZZ as a membership for medical services including primary care, in-home visits, and coordination of specialist care." That's what your CPA needs.
Who actually saves money
Not everyone who deducts the membership saves the same. Two examples.
A 65-year-old retiree with $80,000 AGI in Boca Raton. 7.5% threshold is $6,000. Annual Medicare Part B premium is around $2,000. Supplemental Medigap is another $2,000. Various out-of-pocket prescription and dental costs run another $3,000. A concierge membership of, say, $5,000 brings total medical expenses to $12,000. They deduct $6,000. At their marginal rate of around 22%, that's a $1,320 tax savings. The membership effectively cost $3,680 instead of $5,000.
A 42-year-old professional with $400,000 AGI in Manhattan and a winter place in Palm Beach. 7.5% threshold is $30,000. Even with a high-end concierge membership at $8,000, their total medical expenses don't typically clear $30,000 in a healthy year. They deduct nothing. The membership cost is what they paid.
Both of these people might join the practice. The math is just different for them, and being honest about that is part of why my members tend to be glad they joined.
The snowbird wrinkle
If you split time between Florida and a higher-tax state, the Schedule A medical deduction is one of the cleaner federal benefits available to you. Florida has no state income tax, so all of your tax planning is happening at the federal level anyway. The 7.5% AGI threshold is the same regardless of state.
What matters more for snowbirds is establishing Florida domicile correctly so that state-level taxes (which the higher-tax state would otherwise impose) don't claw back the federal benefit. I wrote a more detailed piece on the snowbird situation here.
One specific thing about the panel size
A reason concierge memberships sometimes hit the 7.5% threshold by themselves is that they're paying for a practice structure that's expensive to run. In my case, capping the panel at fifty patients means every patient is paying a meaningful share of the cost of having me available to them. That's why house calls and same-day visits and 24/7 cell phone access are possible. It's also why the membership is non-trivial.
If you want to think about whether the model fits your life, the cost-benefit question is here. The tax piece is what you're reading now.
Standard disclaimer
I'm a physician, not a CPA. The IRS rules can change. Your situation has specifics I don't know. Use this to start the conversation with your tax preparer, not to skip it.
If you want to talk through whether the practice is a fit, reach out. I'll answer directly.
