His Doctor Will Go Concierge. He Will Pay a $2,400 Annual Fee to Stay in the Practice While Medicare Still Pays for Covered Visits. Declining the Fee Will Mean Finding a New Doctor

He has seen the same internist for years. Then the letter arrives: starting in January, the practice changes to a concierge model, and remaining a patient costs $2,400 a year. The practice says it will keep billing Medicare for his covered visits. The membership fee is his to pay. If he turns it down, he must find a new primary care doctor.

Concierge and direct-primary-care practices are becoming more common. Health Affairs found that the number of those practice sites grew 83% from 2018 to 2023 and that roughly 60% of clinicians at them participated in Medicare. One beneficiary described the same notice on Reddit’s r/medicare forum.

They wrote: “One of my Medicare providers sent an email that they will now be charging an annual fee in addition to insurance coverage”. If your doctor has sent nothing similar, nothing changes for you for now. If a letter like this has landed on your counter, a few Medicare rules decide whether the fee is allowed and what it can buy.

Medicare Can Pay the Visit and Ignore the Membership Fee

Medicare doesn’t cover membership fees for concierge care, and you pay the entire fee yourself. Doctors who offer concierge care must still follow all Medicare rules. In practice, a participating doctor keeps billing Medicare for your covered office visits, and your usual cost sharing doesn’t change. The 2026 Part B deductible of $283 and the $202.90 standard monthly premium still apply. The membership comes on top of both and counts toward neither.

A Legal Fee Must Buy What Medicare Skips

Doctors who accept assignment can’t charge you extra for Medicare-covered services. That means the membership fee can’t hide a surcharge for care Medicare already pays for, such as covered office visits. The fee can pay for clearly identified services or amenities Medicare does not cover, but the practice cannot simply repackage access to Medicare-covered care and charge for it a second time.

Federal regulators enforce this line. The HHS Office of Inspector General has described a case. In it, a physician allegedly violated the assignment agreement because some of the services outlined in the annual fee were already covered by Medicare. If your doctor says Medicare won’t pay for a service it usually covers, Medicare requires a written notice called an Advance Beneficiary Notice of Noncoverage. It lists the service and the reason. A fee sold as the price of keeping your regular checkups, with no extras attached, is a red flag.

Your Real Decision Is Whether to Keep This Doctor

The practice can make the membership a condition of remaining, so declining it can mean losing your doctor, and before you decide, find out how the doctor will bill Medicare after the conversion, because that changes the total cost:

• Participating: The doctor accepts assignment, and you pay standard Medicare cost sharing plus the fee.
• Nonparticipating: The doctor may accept assignment case by case. When the doctor does not, the patient can be charged more than the Medicare-approved amount, generally up to a 15% limit called the “limiting charge.”
• Opted out: Medicare won’t pay for items or services you get from a provider that opts out, except in emergencies, and providers opt out for a minimum of 2 years. You pay whatever the private contract says for every visit, on top of the membership.

A participating doctor charging $2,400 is selling access and continuity. An opted-out doctor charging the same membership plus full visit prices costs far more, and that difference matters more than anything in the welcome packet.

Read the Concierge Contract Before Paying

Get the agreement in writing and check three things before you sign:

1. What the fee buys. Ask for an detailed list of what the membership covers. Compare it with your Medicare-covered services. Anything Medicare already pays for has no place in the fee.
2. What still goes to Medicare. Confirm that the practice will keep billing Medicare and accepting assignment. You can check whether a doctor has opted out in CMS’s public Opt Out Affidavits dataset. Ask whether the membership applies only to the concierge practice and which outside services, such as labs, specialists and hospital care, will continue to be billed separately.
3. Whether you get money back. Find out what happens to a prepaid fee if you move, switch doctors midyear or the doctor leaves the practice. If the contract says nothing, ask for the refund terms in writing.

Medicare notes that state laws and consumer protections may also apply. If the contract appears to charge twice for Medicare-covered care, Medicare or your State Health Insurance Assistance Program can help you sort out the billing rules. Concierge fees are only one surprise cost. Other surprise costs add on top of Medicare’s listed price, and we mapped the rest, from IRMAA surcharges to coverage gaps, in a free guide to Medicare’s hidden bills.

Decide What Continuity Is Worth Before January

Medicare will keep paying for your covered care whichever way you decide. The outstanding issue is whether this one relationship is worth $2,400 a year. A single annual wellness visit means a new participating physician provides the same Medicare coverage with no membership. If you manage several chronic conditions, need the office often or depend on a doctor who knows your history, the access the fee delivers may be worth it. That only holds if the contract lists uncovered extras and the doctor still accepts assignment. Pay for the access only after you know exactly what the fee buys.

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