Direct Primary Care vs Concierge Medicine: Key Differences and Which Fits You Health News
Choosing how to pay for primary care is no longer a simple decision. Two membership-based models have grown beyond the traditional insurance-billed office, and they are often mentioned in the same breath even though they work quite differently. Direct primary care vs concierge medicine comes down to how each practice is paid, what the fee covers, whether insurance and Medicare are involved, and who the model is built to serve. This comparison walks through each of those points using guidance from the American Academy of Family Physicians and Medicare.gov, so you can choose the arrangement that fits your health and your budget.
Direct Primary Care vs Concierge Medicine at a Glance
Both models ask patients for a membership fee in exchange for greater access to a physician, which is why they are so often confused. The American Academy of Family Physicians draws the line clearly: direct primary care typically offers low monthly fees, does not participate in payer programs, and applies membership fees to a broader range of services. See the American Academy of Family Physicians policy on direct primary care for more detail on how the model is defined.
| Feature | Direct primary care | Concierge medicine |
|---|---|---|
| Fee structure | Monthly membership fee paid by the patient, or sometimes the patient’s employer | Annual membership contract with higher fees, payable annually or monthly |
| What the fee covers | Extended visits, clinical, lab, and consultative services, care coordination, and comprehensive care management | An in-depth physical exam and screenings |
| Insurance | Typically not accepted; the practice relies on patient fees | May continue to accept insurance and bill for covered services |
| Government programs | Typically not a participant | May continue to participate, including Medicare |
| Who it serves | Patients across income and demographic levels | Often higher-income patients |
Sources: American Academy of Family Physicians and Medicare.gov
How Each Model Is Paid For
Direct primary care practices rely solely on patient fees, so there are no claims to file and no insurer standing between you and your provider. Concierge practices often have two sources of revenue: the membership fee and, when they still accept insurance, claims billed for covered services. For patients, that second stream means deductibles and copays can still apply to covered care even after the membership fee has been paid.
What Each Membership Fee Covers
The scope of the fee is another dividing line. A direct primary care fee is designed to cover most everyday primary care, from extended visits and lab work to care coordination and ongoing management. A concierge fee, by comparison, is typically tied to an in-depth physical exam and screenings, with covered care often billed to insurance.
Source: American Academy of Family Physicians, Direct primary care: What to know
Direct Primary Care vs Concierge Medicine: How Medicare and Insurance Rules Differ
Insurance involvement is where the two models separate most. Direct primary care practices typically do not accept insurance or take part in government programs. Concierge practices may keep doing both, which pulls them under existing billing rules. According to Medicare.gov, doctors who offer concierge care must still follow all Medicare rules, and Medicare does not cover the membership fee itself.
Source: Medicare.gov, Concierge care
In practice, a concierge doctor who accepts assignment cannot add charges to the membership fee for services Medicare already covers. A doctor who does not accept assignment may charge more than the Medicare-approved amount, but only up to a 15 percent limiting charge. Any Medicare doctor can charge for items and services that Medicare does not cover.
What This Means for Patients With Medicare
Medicare patients can join a direct primary care practice, but the arrangement works differently. At EBO MD, the monthly fee cannot be submitted to Medicare for reimbursement, and members sign a waiver every two years confirming that neither the member nor the doctor will bill Medicare for it. Medicare and supplemental insurance still cover medical costs incurred outside the practice, such as hospital charges, imaging, physical therapy, and prescriptions filled elsewhere. Adults 65 and older join at a senior rate rather than the standard adult rate.
Do You Still Need Insurance With Either Model?
Yes. The American Academy of Family Physicians notes that direct primary care practices often suggest a high-deductible, wrap-around policy to cover emergencies, because some services fall outside the membership fee. EBO MD’s care team takes the same view: membership covers everyday primary care, while insurance remains the safety net for hospital stays, specialists, imaging, and surgery.
Cost and Value: What Patients Actually Pay
The American Academy of Family Physicians reports that direct primary care fees typically range from $50 to $100 per month, while concierge practices use annual membership contracts with higher fees. EBO MD keeps its rates simple and published:
| Membership | Monthly rate |
|---|---|
| Adult (age 19 to 64) | $99 |
| Child (ages 0 to 18), with at least one parent member | $10 |
| Senior (age 65 and older) | $75 |
Members receive unlimited office visits for primary care needs, an annual wellness visit, basic in-office testing, and acute and chronic condition care, with no copays for primary care visits covered by membership. There is no sign-up fee, and a minimum 90-day membership applies. You can review current membership rates for everything included.
| Talk With the EBO MD Team |
Direct Primary Care vs Concierge Medicine Costs Beyond the Fee
The membership fee is only part of the picture, so compare what happens with labs, prescriptions, and covered services. Labs that must be sent out are not part of the monthly fee at EBO MD, but members receive negotiated wholesale lab pricing passed along at no profit to the practice. The office also dispenses wholesale generic prescriptions at wholesale prices. With concierge care, by contrast, claims for covered services continue to flow through insurance, so cost sharing under your plan can still apply on top of the annual fee.
Which Model Fits Which Patient
Neither model is right for everyone, and the American Academy of Family Physicians points out that direct primary care practices often serve all income levels and sometimes contract with local employers. Consider the following:
- Direct primary care may suit you if you want a predictable monthly cost, unhurried access, and a provider relationship that does not depend on insurance billing.
- It also fits families, since a $10 child rate sits alongside an adult membership, and it fits people managing ongoing conditions who benefit from steady contact.
- Employers can offer memberships to their teams through corporate membership for employers.
- Concierge medicine may suit you if you prefer a premium service level, are comfortable with a higher annual fee, and want a practice that continues to bill insurance for covered care.
For a plain-language overview written for patients, see the familydoctor.org guide to deciding if direct primary care is right for you.
Questions to Ask Before You Join Either Model
- What exactly does the membership fee cover, and what is billed separately?
- Does the practice bill insurance or Medicare for any services?
- How quickly can I be seen, and how do I reach a provider after hours? At EBO MD, same-day or, at worst, next-day appointments are the goal, and after-hours access comes through the telehealth membership benefit.
- What do labs and prescriptions cost when they fall outside the fee?
- What is the cancellation policy and the minimum commitment?
Getting Started With Direct Primary Care
If direct primary care sounds like the better fit, joining is simple. The step-by-step enrollment process is to choose a clinic, review membership, enroll online, and schedule your first visit. If you want to talk through your situation first, ask a question and the team will help you compare your options, including the full range of primary care services available to members.
Choose the clinic that fits your routine:
| Clinic | Address | Phone |
|---|---|---|
| Cape Girardeau clinic | 1417 N Mount Auburn Road, Upper Level, Cape Girardeau, MO 63703 | 573-803-2941 |
| Jackson clinic | 1334 Indian Parkway, Jackson, MO 63755 | 573-243-0750 |
| Fredericktown clinic | 605 Lincoln Dr, Fredericktown, MO 63645 | 573-561-5051 |
| Poplar Bluff clinic | 2725 North Westwood Boulevard, Ste 4, Poplar Bluff, MO 63901 | 573-872-4171 |
Frequently Asked Questions About Direct Primary Care and Concierge Medicine
Is direct primary care the same as concierge medicine?
No. Direct primary care typically charges a low monthly fee, does not bill insurance or participate in government payer programs, and applies the fee to a broad range of primary care services. Concierge medicine usually charges a higher annual fee, may still bill insurance for covered services, and often caters to higher-income patients.
Which costs more, direct primary care or concierge medicine?
Concierge medicine generally costs more. The American Academy of Family Physicians reports that direct primary care fees typically range from $50 to $100 per month, while concierge practices use annual membership contracts with higher fees.
Does direct primary care accept insurance?
Typically no. Direct primary care practices rely on membership fees and usually do not accept insurance or participate in government programs, so most patients keep separate coverage for emergencies, hospital stays, and specialist care.
Does Medicare cover concierge medicine fees?
No. Medicare.gov states that Medicare does not cover membership fees for concierge care. Doctors who offer concierge care must still follow Medicare rules, and those who accept assignment cannot charge extra for services that Medicare covers.
Can I join EBO MD if I have Medicare?
Yes. Your monthly membership fee cannot be submitted to Medicare for reimbursement, and you sign a waiver every two years confirming that neither you nor your doctor will bill Medicare for the fee. Medicare still covers medical costs you incur outside the practice.
Do I still need health insurance with either model?
Yes, in most cases. Neither model replaces coverage for hospital stays, specialists, imaging, or emergencies. EBO MD is not insurance and encourages members to keep some level of coverage for care outside the practice.
Can I use an HSA with direct primary care or concierge medicine?
Beginning in 2026, federal law allows a qualifying direct primary care arrangement to coexist with an HSA, with monthly fee limits of $150 for one person and $300 for more than one person. The fixed periodic fee must be the sole compensation for care, so a practice that also bills insurance for visits may not qualify. Confirm eligibility with your plan administrator or a tax professional.
Is there a sign-up fee or long-term contract at EBO MD?
There is no sign-up fee. A minimum 90-day membership is required, and cancellation requires 30 days of written notice.
Ready for primary care without the billing maze?
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EBO MD is not insurance coverage. We encourage patients to maintain some level of health insurance to help cover the costs of medical care that they receive from medical providers/facilities outside of our practice. Insurance will help cover costs associated with, but not limited to, prescription medications, labs, imaging (X-rays, CT scans, MRIs, etc.), specialist consultations, hospitalizations, and surgeries.
If you have questions about how your existing insurance policy will work with direct primary care, contact your insurance provider.