10 Questions to Ask Before Joining a Concierge Medicine Practice

A concierge medicine practice asks you to pay a retainer fee, often annually or monthly, before you receive most services. That financial commitment is different from a standard insurance copay or a one-time cash-pay visit. Because you are prepaying for access, the terms of that arrangement matter as much as the doctor's bedside manner.

The American Academy of Family Physicians notes that concierge and direct-pay models vary widely in structure, fee levels, and what is actually covered. Some practices bill your insurance on top of the retainer. Others are purely cash-pay and do not interact with insurance at all. Knowing which model you are entering before you sign anything is essential. The ten questions below give you a practical framework for that conversation.

Question 1: What is the total cost, and how is it structured? Ask for the full annual or monthly figure in writing. Ask whether there are enrollment fees, administrative fees, or per-visit charges on top of the retainer. Some practices charge a flat membership that covers nearly everything in the office. Others charge a lower retainer but bill insurance or charge cash for procedures, labs, imaging, and specialist referrals. You need the complete picture, not just the headline number. Question 2: Does the practice bill my insurance in addition to the retainer? This is critical. The Centers for Medicare and Medicaid Services has noted that Medicare beneficiaries can belong to a concierge practice, but the practice must follow specific rules about what it can and cannot charge Medicare patients separately. If you have Medicare or a commercial plan, ask exactly which services will be billed to your insurer and which are covered by the retainer. Membership or retainer fees are generally not insurance and do not replace insurance coverage.

Question 3: What is explicitly included in the membership fee? Ask for a written service list. Common inclusions are unlimited or expanded office visits, same-day or next-day scheduling, preventive care visits, and care coordination. Common exclusions are labs, imaging, specialist visits, procedures, and hospital care. A practice that is transparent about its service list is a good sign. If the staff hesitates or gives vague answers, that is worth noting before you commit.

Question 4: How do I reach the doctor after hours, and what is the realistic response time? After-hours access is one of the most cited reasons patients choose concierge medicine. But the actual policy varies. Some practices offer a direct cell phone number with a commitment to respond within a set window. Others route after-hours calls to a nurse line or answering service. Ask specifically: Will I reach my doctor, or a covering provider? Is there a limit on after-hours contacts per month? What happens if my doctor is on vacation? Get the answers in writing if possible.

Question 5: What communication channels does the practice use, and are there limits? Many concierge practices offer secure messaging, video visits, or phone consultations as part of the membership. Ask whether telehealth visits count against any visit cap, whether the platform is HIPAA-compliant, and how quickly you can expect a response to a non-urgent message. The Federal Trade Commission and HHS both maintain guidance on patient data privacy that applies to any digital health communication tool a practice uses, so it is reasonable to ask how your health information is protected.

Question 6: Who manages my care if I am hospitalized? Many primary care physicians, including those in concierge practices, do not have hospital admitting privileges. In most hospitals, a hospitalist, a physician who specializes in inpatient care, manages admitted patients. Ask the practice directly: Will my concierge doctor visit me in the hospital, coordinate with the hospitalist, or have a limited role once I am admitted? Understanding this boundary ahead of time prevents surprises during a stressful situation. The Society of Hospital Medicine describes the hospitalist model and its role in inpatient care on its website.

Question 7: How does the practice handle specialist referrals? Ask whether the practice helps coordinate referrals, negotiates cash-pay rates with specialists, or simply provides a referral letter and leaves the rest to you. Some concierge practices actively advocate for patients through the specialist process. Others treat referrals as outside their scope. If you have a chronic condition or anticipate needing specialty care, this question is especially important. Also ask whether referrals require prior authorization from your insurer if you carry insurance alongside the membership.

Question 8: What are the contract length and cancellation terms? Ask for the membership agreement in writing before you sign. Key terms to review include the contract duration, the notice period required to cancel, whether fees are refundable if you cancel mid-year, and any auto-renewal clauses. Some practices offer month-to-month memberships. Others require a full year upfront. Consumer financial protection principles supported by the Consumer Financial Protection Bureau encourage reviewing any recurring-payment contract carefully before committing. Question 9: Is the retainer fee eligible for HSA or FSA reimbursement? The IRS determines what qualifies as a medical expense under Health Savings Account and Flexible Spending Account rules. As of current IRS guidance, retainer or membership fees for concierge or direct primary care practices are generally not reimbursable from an HSA or FSA unless the fee is specifically for medical care rather than access. This is a nuanced area, and the IRS has issued guidance on it. Ask the practice whether they have reviewed their fee structure for HSA eligibility, and consult a tax professional for your specific situation. IRS Publication 502 covers qualified medical expenses in detail.

Question 10: What happens if the physician leaves, retires, or the practice closes? This is a continuity-of-care question that patients often overlook. Ask whether the practice has a succession plan, whether another physician would take over your care, and whether you would receive a prorated refund of your retainer if the practice closes mid-contract. Also ask how your medical records would be transferred. Under HIPAA, you have the right to access and transfer your medical records, but the process is smoother when you understand the practice's specific procedures in advance. HHS maintains patient rights guidance on its website.

Most concierge practices offer a meet-and-greet or consultation visit before you enroll. Bring this list of questions in writing. A practice that welcomes detailed questions and provides clear, written answers is demonstrating the transparency that should define the relationship going forward. A practice that deflects, rushes you, or gives inconsistent answers is giving you useful information too.

Take notes during the consultation and ask for any verbal commitments to be reflected in the membership agreement. If the practice uses a standard contract, read every section before signing. Pay particular attention to sections covering fee changes, termination rights, and what services are excluded. If you carry health insurance, confirm with your insurer how the concierge membership interacts with your plan, especially for preventive services that may be covered at no cost under the Affordable Care Act as described on HealthCare.gov.

DirectMedicine is a directory of direct-pay, cash-pay, and direct primary care practices across the United States. When you search for a concierge or direct-pay provider on DirectMedicine, you can compare practices based on the information they choose to publish publicly, including membership structures, services offered, and contact details. That transparency lets you start the vetting process before you ever pick up the phone.

The ten questions in this article are designed to guide the conversation once you have identified a practice that looks promising. DirectMedicine does not endorse specific providers or guarantee any practice's pricing or terms. What it does is put transparent-care options in one place so you can do your due diligence efficiently. Use the directory to build your shortlist, then use these questions to make your final decision with confidence.