10 Questions to Ask Before Joining a Concierge Medicine Practice

Concierge medicine practices charge a recurring membership fee, often monthly or annually, in exchange for enhanced access to a primary care physician. That model can offer real benefits: longer appointments, same-day or next-day availability, and a doctor who knows you well. But the details vary widely from one practice to the next, and the fee structure is not standardized across the industry.

Because membership fees are a direct out-of-pocket cost and concierge membership is not health insurance, you carry the financial risk if the practice does not deliver what you expected. The American Academy of Family Physicians notes that direct-pay and concierge arrangements differ from traditional insurance-based care in important ways that patients should understand before enrolling. Asking the right questions upfront lets you compare practices honestly and choose one that fits your health needs and budget.

Question 1: What is the total annual or monthly cost, and what does it cover? Ask for a written list of every service the membership fee includes. Common inclusions are unlimited or expanded office visits, preventive care, basic lab work, and care coordination. Common exclusions are specialist visits, imaging, hospitalizations, and prescription drugs. Get the list in writing before you commit.

Question 2: Is there a contract, and what is the cancellation policy? Some practices require a 12-month commitment; others bill month to month. Ask whether you receive a prorated refund if you move, become seriously ill, or simply change your mind. Understand any notice period required to cancel without penalty.

Question 3: Does the practice also bill my insurance or Medicare for any services? Some concierge practices operate on a pure cash-pay basis and do not bill insurance at all. Others collect a membership fee but still submit claims to insurance for individual visits. The Centers for Medicare and Medicaid Services has published guidance clarifying that Medicare beneficiaries may pay a concierge fee for non-covered amenities, but a physician who opts out of Medicare cannot bill Medicare for covered services. Ask the practice directly how it handles Medicare and private insurance so you understand your full cost picture.

Question 4: How do I reach the doctor after hours or on weekends? One of the most-cited reasons patients choose concierge practices is the promise of direct physician access. Ask specifically whether you can call or text the doctor's personal line, whether after-hours calls go to a covering physician or an answering service, and how quickly you can expect a response. Get the answer in writing, not just as a verbal assurance during a sales conversation.

Question 5: What is the typical wait time for a same-day or next-day appointment? Enhanced access is only meaningful if the practice actually delivers it. Ask how many patients are currently enrolled, what the target panel size is, and whether the practice has a waitlist. A smaller patient panel generally supports faster access. The AAFP has noted that direct-pay and concierge models often limit panel sizes specifically to improve availability, but the actual numbers vary by practice.

Question 6: How does the practice handle referrals to specialists? Ask whether the doctor actively coordinates your care when you need a cardiologist, dermatologist, or other specialist, or whether you are simply handed a name and left to schedule on your own. Some concierge practices emphasize care coordination as a core service; others do not. If you have a chronic condition that requires regular specialist involvement, this question is especially important.

Question 7: Does the practice have preferred relationships with specialists who offer transparent or discounted pricing? Some concierge and direct-pay practices have built networks of cash-pay specialists or imaging centers that offer lower self-pay rates. If you do not carry separate insurance, knowing whether your primary care doctor can point you toward affordable specialist options could save you significant money. Ask whether those referral relationships are formal or informal, and whether the practice has any financial arrangement with those specialists you should know about.

Question 8: What happens if I need to be hospitalized? This is one of the most important questions patients forget to ask. Concierge membership covers primary care, not hospital care. Ask whether your doctor has admitting privileges at a local hospital, whether they will visit you if you are admitted, or whether your care transfers entirely to a hospitalist team. Understanding this gap helps you decide whether you also need a separate health insurance plan or a hospital indemnity policy to cover inpatient costs.

Question 9: How does the practice handle emergencies and urgent situations outside normal hours? Ask what the protocol is if you have chest pain at 2 a.m. or a child with a high fever on a Sunday. A well-run concierge practice should have a clear, written protocol that tells you exactly when to call the doctor directly, when to go to urgent care, and when to call 911. If the practice cannot give you a clear answer, that is useful information.

Question 10: What are the doctor's credentials, and how long has the practice been operating? You can verify a physician's board certification through the American Board of Medical Specialties at abms.org, and you can check for disciplinary history through your state medical board. Ask how long the doctor has been in concierge practice, whether they plan to stay in the area, and what happens to your membership if the practice closes or the doctor retires. A practice that has operated for several years and has a clear succession plan offers more stability than one that just opened.

Also ask about the support staff. Does the practice have a nurse or medical assistant who handles routine questions? Is there a patient portal for messaging and records access? These operational details affect your day-to-day experience as much as the doctor's credentials do. A thorough practice will welcome these questions and answer them clearly.

Concierge membership fees are not health insurance premiums, and they are not automatically eligible for payment from a Health Savings Account. The IRS has issued guidance indicating that direct primary care arrangement fees may be eligible for HSA reimbursement under certain conditions, but the rules are specific and have evolved over time. Review IRS Notice 2023-37 and consult a tax professional before assuming your HSA can cover a concierge membership fee.

Because concierge membership is not insurance, patients who rely solely on a concierge membership for healthcare coverage carry full financial exposure for hospitalizations, specialist visits, surgeries, and emergency care. The Health Insurance Marketplace at HealthCare.gov remains an option for patients who need coverage for those higher-cost events. Many patients pair a concierge or direct primary care membership with a high-deductible health plan or a health-sharing arrangement to cover catastrophic costs.

DirectMedicine is a free directory of direct-pay, cash-pay, and direct primary care practices across the United States. Each listing shows the practice's location, contact information, and the type of care model it uses, so you can identify concierge medicine practices in your area and reach out directly to ask the questions covered in this article.

Because DirectMedicine focuses on transparent-care providers, the directory makes it easier to compare practices side by side before you commit to a membership. You can filter by location and care model, then contact each practice to request their written fee schedules and membership terms. That comparison step, done before you sign anything, is the most practical way to find a concierge practice that matches your needs and budget.