If I have Medicare, do I need a concierge medicine practice? If my doctor is in a concierge medical group, do I need Medicare? What are the problems with a concierge service? Georgia Medicare supplement plans look at the pros and cons of merging Medicare with concierge medical services.
What is a concierge doctor?
Concierge doctors generally offer their services direct to patients in exchange for an upfront monthly or annual fee. Direct primary care (DPC) is another term for a concierge practice. Built on the concept of “cutting out the middleman” (the insurance carrier), the idea is the patient SHOULD receive better care at a lower cost.
Is Concierge Medicine Worth the Extra Cost?
Patients who require a lot of primary care services may benefit from the extra fees associated with a concierge practice.
Concierge medical groups offer a wide range of primary health care services, generally for a flat monthly or annual fee.
Truth be known, you do not need health insurance to cover most primary care services . . . but too many patients have become CONDITIONED to BELIEVE they cannot afford to go to a doctor unless they have health insurance.
Concierge services used to be common only among wealthy patients who could afford the fees, but in recent years, concierge medicine has become more affordable.
How Much Are Concierge Fees?
A new client recently asked me to review a specific concierge medical group suggested by a friend who as Medicare. Below is my response.
The lines between what is included in your monthly fee and what will cost extra are a bit blurred based on the website information. They want you to call for a “customized” plan and quote.
It looks like the monthly “premium” is $275 for an individual but can go higher. Other folks who have a concierge provider generally pay around $150 per month.
A routine dermatology visit is $250 . . . I paid $91 two weeks ago (Medicare price)
They also have agents who will try to sell you insurance for hospitalization, ER, surgery . . . etc.
Looks like a lot of . . . embellishment . . . on the linked page above
They also offer DPC (Direct Primary Care) for $100/month . . . a bit more reasonable but seems excessive unless you are a major consumer of healthcare services
SOME concierge plans do not accept insurance assignment and many will not file claims with Medicare.
I can’t find anything regarding insurance plans they accept . . . perhaps I missed it . . . or maybe they don’t accept any plans.
This practice does not appear on the Medicare physician finder.https://www.medicare.gov/care-compare/?providerType=Physician&redirect=true
Spot checking a few docs against the Medicare site, I don’t see the following . . .Bianco, Evans, Beaulieu, Osinubi, Boland
I did find Faruque, Lothe, Rabbi . . . they seem to be part of another practice that DOES take Medicare . . . not sure of the concierge connection
You should ask them if you are considering a membership, but Medicare acceptance seems to be nonexistent unless you get your care “offsite” at a practice.
What are the Pros and Cons of Concierge Medicine?
First, the pros . . .
“No wait” doctor appointments
24/7 access to phone advice from a medical professional
Telemedicine (virtual) appointments
Some practices include medical specialists
Coordinated health care between primary care and special services
Are there cons to concierge medical services?
Membership fees are IN ADDITION to Part B and Medigap premiums
Concierge fees are not reimbursed by Medicare or your supplement plan
Most concierge medical groups do not accept Medicare, Medicaid, Tricare or Medicare Advantage
Compare what you “get” for your concierge fees vs your out of pocket costs with a Medigap plan
Currently, your out of pocket cost for Medicare and a Medigap G plan is less than $250 per year. Do you see any value in paying extra for essentially the same care you get without a concierge plan?
Enrolling in a concierge practice means you will probably want to sever relationships with your existing doctors
Do I need concierge medicine in addition to Medicare?
For starters, Medicare does not cover treatment received from a concierge practice. Medicare will not reimburse you for concierge fees and most of these medical groups will NOT bill Medicare. Even if they did Medicare will reject the claim since even if submitted to Medicare for reimbursement.
Do I need a Medicare supplement plan and concierge medicine?
A Medigap (Medicare supplement plan) covers much more than just primary health care, so yes, it is advisable to have a Medicare supplement plan. In addition to doctor visits (primary care and specialist), your Medigap plan covers cancer treatment including chemotherapy and radiation therapy, outpatient surgery, ER (emergency room), MRI, CT scans, physical therapy and more.
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