Short answer: It may help older adults who want longer visits and easier access, but Medicare does not pay the membership fee. You would still need Medicare or other coverage for hospital care, specialists and drugs. Compare the fee with what you spend now, and ask the practice how it works with Medicare.
Direct primary care (DPC) is a membership model. You pay a monthly fee to a doctor's office instead of the office billing insurance for each visit. familydoctor.org, the patient website of the American Academy of Family Physicians, says membership often brings longer visits with your doctor. It also says it can be easier to see your doctor quickly and more often. Patients can reach the doctor by text, phone or email, and some practices offer same-day appointments.
These can matter if you have several health conditions or many medicines to keep track of. A longer visit gives you time to ask questions. Whether it is worth it depends on how much you value that time.
The Medicare.gov page about concierge care, a similar model where you pay a membership fee, says Medicare does not cover membership fees. It also says you pay all costs for services Medicare does not cover, including that fee. Medicare.gov says concierge care is also called direct care, among other names. Medicare.gov also says a doctor who accepts Medicare assignment cannot charge you extra for services Medicare covers. Please ask both the practice and Medicare about your own situation.
The American Academy of Family Physicians says DPC practices typically do not accept insurance or take part in government programs. Medicare.gov also explains that some doctors opt out of Medicare. If you see a doctor who has opted out, you may have to sign a private contract, and Medicare will not pay for any service from that doctor, even one Medicare usually covers. Medicare.gov notes an exception for emergencies. Medicare.gov suggests calling your State Health Insurance Assistance Program (SHIP) before you sign a private contract.
A DPC membership is not insurance. The American Academy of Family Physicians says practices often suggest separate coverage for emergencies and other care, because some services fall outside the fee. For an older adult, that usually means keeping your Medicare coverage for hospital stays, specialists and prescription drugs. Please do not drop any coverage because you joined a DPC practice.
Add up a year of what you pay now for doctor visits, copays (the fixed amount you pay at each visit) and urgent care trips. Then add the yearly cost of the membership fee, which you would pay on top of your Medicare costs. Ask which labs, drugs and procedures cost extra. familydoctor.org says these are often discounted at a DPC office. Some employers pay part of the fee, and some practices offer discounts for people with low incomes.
You can find a direct-pay doctor near you and call to compare. If you are new to the idea, read what direct primary care is.
Medicare.gov says Medicare does not cover membership fees for concierge care, which it says is also called direct care. Ask the practice and Medicare about your situation.
Yes. A DPC membership is not insurance, and practices often suggest separate coverage for services outside the fee, such as hospital care.
Medicare.gov says that if you see a doctor who has opted out of Medicare, you may need to sign a private contract and Medicare will not pay for services from that doctor. It suggests calling your SHIP first.
