Concierge Healthcare Plans: Wave of the Future?
By Michelle Ash
In this blog entry, we’ll discuss the 5th of the 7 options a pre-Medicare retiree may have available: concierge healthcare.
Concierge healthcare may be the newest of these pre-Medicare choices; it’s certainly the most rapidly changing. It stems from the dissatisfaction of patients and practitioners alike with the current healthcare system in the United States. Instead of long waits for an appointment where the physician may only have 15 minutes to see the patient, uncertain costs, and insurance haggling, concierge care seeks to do things different, and better, for all parties involved.
What Is Concierge Healthcare?
Concierge healthcare is a membership-based care plan from the practitioner or facility you join. Similar to joining a gym, or subscribing to an online streaming service like Netflix, you pay a monthly or annual fee to join the membership of your chosen practitioner, which then entitles you to the services included in that membership. Typical services include rapid access to office visits, ability to text with your physician, telemedicine appointments, and inclusion of routine services in the membership cost. This may include things like annual physicals, preventive screenings, or lab work. Another hallmark of most concierge plans is the amount of time your physician can spend with you, which may be 30 to 60 minutes.
How is this possible? The patient load carried by most membership-based physicians is far lower than that of traditional practices because the physicians can set their own prices and know what they will get paid, rather than an insurance company deciding it for them. This provides better quality of life for the physicians, many of whom are struggling with burnout and leaving the field of medicine due to heavy daily appointment loads and frustrations with inability to provide the level of care they’d prefer to provide to patients.
What Concierge Healthcare is NOT: Insurance!
Just as important as knowing what concierge healthcare is, and how you might benefit from it, it’s important to know its limitations. First and foremost, it is not health insurance. This means that most individuals considering this type of healthcare will use it in addition to insurance. Many health insurance experts suggest that it can be ideal to combine a concierge plan with a high deductible insurance plan, because the routine care you need could be covered by the concierge plan, while unforeseen or urgent medical issues can be covered by insurance. Concierge healthcare’s costs are not deductible with your insurance company, and do not serve to meet any copays or other insurance-related costs. However, if a concierge physician recommends other medical professionals, tests, lab work or similar items, your insurance may cover those, depending on your insurance plan.
Who Should Consider Concierge Healthcare?
When concierge healthcare first emerged, it was positioned most commonly in a couple of ways: either for primary care needs, under which it’s also named “DPC” – Direct Primary Care, or a way to work with specialists. Good examples of individuals who should consider those models of concierge care include parents of young families who find themselves at the pediatrician’s office frequently, or individuals with chronic care issues who see a particular specialist often. Why might concierge care be good in these situations? The rapid access to care, deeper relationship with the practitioner, and flat fees might make it a better fit for both needs and costs.
As concierge healthcare has continued to gain interest, other possibilities have emerged. For example, some urgent care facilities are offering membership plans as a way to have fast and easy access for both minor issues, like colds, flu, or ear infections, as well as major issues like car accidents which may include the need for CT scans, x-rays, and lab work. Individuals can join, but so can small businesses, especially those that might not otherwise offer a group healthcare plan to employees. Membership may include all of these items without additional cost, or minimal extra cost. While this still wouldn’t replace health insurance, it may allow individuals buying insurance to purchase a lower cost plan, or higher deductible plan, knowing that many more of their unexpected needs have a cost cap.
Some concierge plans have started to offer different packages to meet different needs. For example, a primary care physician might offer the standard model mentioned previously in this article, but also offer a lower cost plan that eliminates in-person visits and lab work, but offers telemedicine appointments, and ability to text or email on an unlimited basis with the physician.
What Does It Cost?
Most concierge healthcare plans range from $100/month ($1200/year) to as high as $20,000/year for more specialized services.1 However, as the marketplace for these services continues to develop, more economical plans are also becoming available. The question for consumers and practitioners alike will be whether this model can deliver on the improvements in both quality of care and quality of life for the practitioner that it seeks to provide. Like many things in business, it’s likely that some providers will thrive, while others will struggle. Some consumers will find value in these plans, and others won’t use it enough to justify the additional expense on top of insurance. If you believe a concierge healthcare plan may be right for you, be sure to consider how you’ll use it, how often, and how the cost fits into your budget.
Additional Resources
Searching online for concierge practitioners in your area can be a great way to learn more about offerings in your community.
For a video discussion about all 7 of the pre-Medicare healthcare options this blog series is overviewing, be sure and check out our video recording.
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