Concierge health practices and Medicare

Mike – California: I’m not clear on how concierge care intersects with Medicare. I’ve read about ethical concerns that a concierge doctor gets paid twice. How? I currently pay an annual amount to the doctor and what happens in his office — physical exam, consultation, maybe a flu shot, a small procedure (he helped with a corn/callus) — all goes without charge. Yes, my employer insurer applies for prescriptions, lab work, x-rays, etc. If I can afford the annual fee and want the benefit of speedy office access and email and phone availability, the annual fee could be a good buy that doesn’t terribly exceed traditional visit co-pays to a doctor I might not otherwise choose.

Phil Moeller: Medicare works with concierge practices. It’s up to a concierge physician whether or not they want to accept Medicare patients and whether or not they are willing to accept assignment from Medicare.

Assignment means the health care provider agrees to accept Medicare-approved charges as payment in full for their services. Most doctors who accept Medicare also accept assignment, but it’s possible for a doctor to accept Medicare patients without agreeing to assignment. Such “non-participating” doctors can bill you more than the Medicare-approved amount for their services, although Medicare rules limit such overcharges. Medicare will still work with such doctors, but you should be aware of the billing situation in advance.

Your doctor’s office should be able to explain all of this to you, including details of whether the doctor will be submitting claims to Medicare for reimbursement of covered services or if that’s something you need to do. Medicare does not cover concierge fees, and the doctor should not be billing Medicare for the services provided in exchange for concierge fees.