The costs associated with health insurance, long term care, and end of life care are increasingly shifting to individuals, and are an important part of the financial planning we do with clients. In addition, some clients feel that accessing their medical providers is difficult and that they spend less time than they would like once they do see them. An alternative that some people are turning to is the "concierge medicine" model. We have discussed this with a few of our clients and thought it would be worthwhile to share with you how these plans work and who might benefit from them.
The term "concierge" applies to a variety of different payment and access models. Some providers charge a retainer that can range substantially in price depending on the services offered. For example, Stanford Concierge Medicine charges approximately $3,000 to $5,000 annually per person for their Concierge plan, higher than some plans but lower than others. The retainer type service offers flexible appointments and greater access to primary care physicians. The plans may offer house calls, elegant waiting rooms, and coordination of care among providers. Physicians who participate in these programs serve fewer patients and are able to spend more one-on-one time with each patient.
These models typically will also charge your insurance company fees for visits and your insurance will cover tests, imaging, and medications according to its policies.
Some "concierge" providers follow a direct pay model. They offer similar advantages to the retainer model but do not work with insurance companies and charge patients directly for care. These plans may be worthwhile for people with high deductible health plans (HDHPs). If an insurance policy doesn't begin to pay until the patient is out of pocket by several thousand dollars, it may be more cost effective to seek care from physicians who do not accept insurance but whose covered services include such things as lab work, x-rays, and other services that wouldn't be covered under the HDHP plan. Physicians who are adopting these models claim that avoiding the administrative costs of dealing with insurance companies allows them to reduce their charges to patients. It may be possible to pay for some of the cost of "concierge" services from Health Savings Accounts. However, a retainer that pays for better access is not considered a qualified medical expense for HSA/FSA reimbursement purposes.
A positive outgrowth of the concierge medicine movement has been an adoption by some health providers such as the Palo Alto Medical Foundation and Kaiser to provide similar, easier access approaches to their physicians. Clients should be aware that while these "concierge" models have been growing in popularity in recent years, there is no evidence linking this approach to better medical outcomes (Annals of Internal Medicine. 2010; 152(6):391-392).
So much is changing in the delivery of care and the options available. Exploring these new concierge models as an addition to existing insurance plans may be worth it for those who can afford the retainer and desire greater flexibility and easier access to physicians. As always, we recommend that if you are considering these options it is best to consult with an independent insurance professional and with your financial advisor.
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