Some doctors are beginning to switch to a concierge practice model, where they offer comprehensive services for a flat annual or monthly fee instead of charging patients for each individual service they receive. Some practices may also provide additional personalized services like a wider range of available appointment times or after-hours phone or email access to doctors.
This practice model can work with Medicare, but there are specific things to be aware of if a client is considering coordinating their Medicare benefits with a concierge practice.
Many concierge practices simply don’t take insurance at all – Many providers are switching to the concierge model to avoid the limitations on reimbursement from Medicare or private insurance and to save them the work of submitting claims. If a client’s existing doctor is considering switching to a concierge model, it’s important for them to find out if the practice will remain willing to work with the Medicare program at all, or will be opting out entirely.
Concierge practices cannot charge access fees or administrative fees without providing additional benefits to members – If a concierge practice that does still accept Medicare assignment charges any kind of administrative or membership fees to Medicare beneficiaries, they must be providing some kind of services to the member beyond what would be covered by Medicare. If not, the fee is considered double billing and is against federal regulations. See page 15 of this document.
If a provider in a concierge practice has opted out of Medicare entirely, the member cannot file claims themselves – Providers who have opted out of Medicare are required to enter into a private agreement with patients, entirely removed from Medicare. This includes members paying out of pocket for services and then filing a claim with Medicare themselves. If a provider has opted out, any services offered are no longer considered Medicare eligible.
If you’re unsure, clients can always check Physician Compare on Medicare.gov for information on whether a provider participates in the Medicare program.