10 Questions to Ask Before Joining a Concierge Practice

Concierge medicine practices charge a recurring membership or retainer fee in exchange for enhanced access to a primary care doctor. That fee can range from a few hundred dollars a year to several thousand, depending on the practice model and location. Because you are committing real money upfront, it pays to ask hard questions before you sign anything.

The American Academy of Family Physicians notes that direct-pay and concierge arrangements vary widely in what they include and how they bill. Some practices still bill your insurance for individual visits on top of the retainer. Others are purely cash-pay and do not submit claims at all. Knowing which model you are looking at changes every other question on this list.

A good practice will welcome your questions. If a doctor or office manager gets defensive or vague, that is useful information too. Think of this checklist as a job interview where you are the one doing the hiring.

Question 1: What is the total annual cost, and how is it billed? Ask for the exact figure, whether it is billed monthly, quarterly, or annually, and whether the fee ever changes mid-contract. Some practices offer family rates or sliding scales, so ask about those too. Do not assume the advertised number covers everything.

Question 2: What services are included in the membership fee? A written list matters here. Common inclusions are unlimited or expanded office visits, same-day or next-day appointments, telehealth calls, basic in-office labs, and care coordination. Common exclusions are imaging, specialist visits, hospital care, and prescription costs. Get the list in writing so you can compare it against another practice.

Question 3: Does the practice also bill my insurance or Medicare for visits? Some concierge practices collect a retainer and still submit claims to your insurer for individual services. Others do not bill insurance at all. The Centers for Medicare and Medicaid Services has published guidance clarifying that Medicare beneficiaries can use concierge practices, but the rules around what can and cannot be billed to Medicare are specific. Ask the practice directly how it handles Medicare or private insurance billing before you assume anything.

Question 4: How many patients are in your panel, and is that number capped? One of the main reasons people choose concierge medicine doctors is the promise of shorter wait times and more face time with their physician. That promise depends on a smaller patient panel. Traditional primary care panels can exceed 2,000 patients per doctor, according to research cited by the AAFP. Concierge panels are often far smaller, but the specific number varies by practice. Ask what the current panel size is and whether the practice is still accepting new members.

Question 5: How do I reach you after hours or on weekends? Ask whether after-hours access means a direct phone number to your doctor, a nurse line, a shared on-call physician, or a message that gets answered the next business day. These are very different levels of access. Also ask what happens when your doctor is on vacation. Knowing the backup plan before you need it prevents frustration later.

Question 6: How do you handle specialist referrals? Concierge primary care covers primary care, not specialty care. Ask whether the practice has established relationships with local specialists, whether those specialists accept cash-pay patients, and whether the doctor will coordinate with a specialist on your behalf. Some concierge doctors actively manage specialist relationships as part of their service. Others hand you a name and leave the rest to you.

Question 7: What happens if I need a hospital, emergency room, or urgent care visit? Concierge membership does not replace health insurance for hospitalizations, surgeries, or emergency care. The practice should be transparent about this. Ask whether your doctor has hospital admitting privileges, whether they will communicate with the hospital team if you are admitted, and what role the practice plays if you end up in the ER. This is also a good moment to confirm that the membership is not insurance, because it is not, and you may still need a separate health plan or a cost-sharing arrangement for major events.

Question 8: What are the cancellation and refund policies? Ask how much notice you need to give to cancel, whether you get a prorated refund if you leave mid-year, and what happens to your medical records when you leave. Federal law gives patients the right to a copy of their records, but the process and any associated fees vary by state. Your state medical board can clarify your rights if you have questions.

Question 9: Can I use an HSA or FSA to pay the membership fee? This is a tax question, not a medical one, and the answer depends on how the practice structures its fees. The IRS has issued guidance indicating that direct primary care arrangement fees may qualify as medical expenses for HSA purposes under certain conditions, but the rules are specific. The IRS website at IRS.gov is the authoritative source, and a tax professional can help you apply the rules to your situation. Do not assume the fee is automatically HSA-eligible without checking.

Question 10: Can I meet you before I commit? Many concierge practices offer a meet-and-greet visit or a brief phone call before enrollment. Use that time to assess communication style, whether the doctor listens, and whether the practice feels organized. A membership can last years, so personal fit matters as much as the fee structure.

Also ask about the doctor's background, board certifications, and how long they have been practicing in this model. You can verify board certification status through the American Board of Medical Specialties at abms.org, and you can check for any disciplinary history through your state medical board. These are standard due-diligence steps, not signs of distrust.

Finally, ask what the practice does if the doctor retires, moves, or closes the practice. Knowing the succession plan protects you from losing both your doctor and your prepaid fees at the same time.

DirectMedicine is a free directory of direct-pay, cash-pay, and direct primary care practices across the United States. When you search for concierge medicine doctors on DirectMedicine, you can filter by location and care model, then review each practice's listed services and contact information so you can reach out with the questions from this checklist.

The directory is built around price transparency and patient empowerment. Practices that list on DirectMedicine are direct-pay providers, which means you can have a straightforward conversation about fees without going through an insurance intermediary. That makes it easier to compare two or three practices side by side before you commit.

DirectMedicine does not endorse specific providers or guarantee any particular outcome. What it does is put the information in one place so you can do your own research, ask the right questions, and make a decision that fits your health needs and your budget.