How to Choose a Concierge Doctor: A Practical Patient Checklist

A concierge medicine doctor charges a recurring membership fee, sometimes called a retainer, in exchange for more direct access and a smaller patient panel. That fee is separate from any insurance you carry. The American Academy of Family Physicians notes that direct-pay and concierge models vary widely in what they include, so two practices using the same label can offer very different things. Understanding that difference is the first step before you compare any two doctors.

Because the membership fee is not insurance, it does not count as a health plan under the Affordable Care Act. HealthCare.gov is clear that a concierge or direct-pay membership does not satisfy the requirement to have minimum essential coverage if that requirement applies to you. You may still want or need a separate insurance policy or a cost-sharing arrangement for hospitalizations, specialist visits, and emergencies. Keep that in mind as you budget.

Panel size is one of the most important numbers to ask about. A traditional primary care physician may carry a panel of 1,500 to 2,500 patients or more. Concierge practices typically limit their panels to a few hundred patients, and some direct primary care practices go even lower. A smaller panel is the main reason these doctors can offer same-day or next-day appointments and longer visit times. Ask the practice directly: how many patients are currently on the panel, and is there a cap?

A practice that is already near its cap may not be able to give you the access it promises. Ask whether there is a waitlist and how long it typically runs. Also ask what happens to your care if the doctor leaves the practice or retires. Getting clear answers to these questions before you join protects you from a situation where the access you paid for is not actually available.

Concierge fees vary considerably across the country and across practice types. Some practices charge a flat annual retainer. Others bill monthly. Some include a broad set of services in the base fee, such as routine labs, preventive screenings, and telehealth visits. Others charge the membership fee for access only and bill separately for each service. Always ask for a written list of exactly what is and is not included before you commit.

Tax treatment is another practical question. The IRS has issued guidance indicating that direct primary care arrangement fees may be eligible for payment from a Health Savings Account under certain conditions, but the rules are specific. IRS Notice 2023-37 addressed this topic in the context of high-deductible health plans. Talk to a tax professional about your own situation rather than assuming the fee is HSA-eligible. Similarly, ask the practice whether they bill your insurance for any covered services on top of the membership fee, or whether they operate entirely outside of insurance billing.

One of the main reasons patients choose a concierge medicine doctor is better communication. Before you join, ask specifically how you reach the doctor after hours. Does the practice offer a direct cell phone number, a secure messaging app, or a patient portal? Is there a nurse line? What is the typical response time for a non-urgent message? Get these answers in writing or at least confirmed in your membership agreement, because verbal promises are hard to enforce.

Ask about telehealth too. Many concierge practices offer video or phone visits as part of the membership, which can save you a trip for minor concerns. Find out whether telehealth visits are available across state lines if you travel frequently. The Health Resources and Services Administration tracks telehealth policy changes that affect what doctors can do remotely, and rules can vary by state. A good practice will be upfront about any limitations.

Read the membership agreement carefully before you sign. Look for the cancellation policy. Can you leave with 30 days notice, or are you locked in for a full year? Is any portion of the fee refundable if you cancel mid-term? Some practices prorate refunds; others do not. Understanding this protects you if your circumstances change, you move, or the relationship simply is not a good fit.

Also ask what happens to your medical records if you leave. Under federal rules, you have the right to access and receive a copy of your health records. The HHS Office for Civil Rights enforces HIPAA rights around medical records access. A reputable practice will have a clear process for transferring your records to a new provider. Ask about the timeline and any fees for record transfer before you join, not after you decide to leave.

A concierge primary care doctor handles primary care, not specialty care or hospital medicine. Ask the practice how they handle referrals. Do they have relationships with specialists who offer transparent or discounted pricing for cash-pay patients? Will the doctor coordinate with a specialist on your behalf, or does that coordination stop at the referral letter? Some concierge practices take an active role in care coordination; others hand off and step back.

For hospitalizations and emergencies, your concierge membership almost certainly does not cover inpatient care. Ask the practice directly what their role is if you are admitted to a hospital. Some concierge doctors maintain hospital privileges and will follow you as an inpatient; many do not. This is a critical gap to understand before you decide whether to carry a separate insurance policy or a health-sharing arrangement alongside your membership.

Use these questions as a starting point when you meet with or call a concierge practice. What is the current panel size and the maximum cap? What is included in the membership fee, and what is billed separately? How do I reach the doctor after hours, and what is the expected response time? What is the cancellation policy and refund policy? How are my records transferred if I leave? Does the practice bill insurance for any services, or is it entirely cash-pay? How does the practice handle specialist referrals and hospitalizations?

Write down the answers you receive. A trustworthy practice will welcome these questions and give you clear, consistent answers. If a practice is vague about fees, panel size, or contract terms, that vagueness is itself useful information. You want a doctor-patient relationship built on transparency, and the way a practice handles your questions before you join is a preview of how they will handle your care after you join.

DirectMedicine is a directory built specifically for patients looking for direct-pay, cash-pay, and direct primary care providers across the United States. When you search on DirectMedicine, you can compare practices by location and care model, and view the information each practice has chosen to publish about their services and approach. The goal is to put transparent, comparable information in one place so you can do your homework before you make a call.

No directory can make the final decision for you, and DirectMedicine does not endorse specific providers or guarantee any particular outcome. What the platform does is reduce the time you spend hunting for basic information so you can focus your energy on the questions that matter most, like the ones in the checklist above. Start your search, make a short list of practices that look like a fit, and then use this guide to ask the right questions.