Concierge Medicine vs. Direct Primary Care vs. Traditional Insurance: A Plain-English Comparison

Patients ask me some version of this question nearly every week. Is concierge medicine the same thing as direct primary care, and do I still need insurance for either one? The confusion is not their fault. The terms get used interchangeably in news coverage, in marketing copy, and sometimes by practices themselves.

Here is the part almost nobody explains. "Concierge" was never one thing. A 2010 analysis prepared for MedPAC by NORC at the University of Chicago found three distinct retainer models operating under the same label, and they differ in the one way that actually affects your wallet.

I run a direct primary care practice, so I have an obvious bias. I am going to argue against it wherever the evidence says I should. There are people for whom DPC is a poor financial decision, and I would rather say so plainly than have someone join, feel misled, and leave six months later.

Key Takeaways

• One question sorts every practice: does it bill your insurer? Traditional does. Concierge does, and adds a fee on top. DPC bills no one.
• "Concierge" covers three separate retainer models identified in a MedPAC contractor report, which is exactly why the word confuses people.
• DPC averaged roughly $98 per member per month in 2024 survey data from 465 practices; concierge fees were reported at $1,000 to $50,000 a year in 2025.
• Neither membership model replaces insurance. Arizona law states flatly that a DPC agreement "is not insurance."
• The best cost study found utilization dropped sharply while net employer cost rose 1.3%. Choose DPC for access, not savings.

Why does "concierge medicine" mean three different things?

Because it always has. In October 2010, NORC at the University of Chicago reported to MedPAC that retainer-based practices came in three forms: "fee for extra services," "fee for care," and hybrids of the two. The first type, which charges a fee and still bills Medicare and insurers, was the most common.

The "fee for extra services" model is what most people picture when they hear the word concierge. You pay an annual retainer for amenities: same-day appointments, your physician's cell number, an extended physical, coordination when you land in the hospital. Your actual visits are still billed to your insurance plan exactly as they were before.

The "fee for care" model works differently. The periodic fee covers your primary care outright, and the practice bills no insurer for it. That is the model the industry now calls direct primary care. The hybrid sits between them, usually running a retainer panel and a conventional insurance panel side by side.

So when a neighbor says their doctor "went concierge," you still know almost nothing useful. You do not know the fee, the panel size, or whether insurance is still in the picture. That last one is where nearly every misunderstanding starts.

What is the one question that sorts every practice?

Ask whether the practice bills your insurer. The American Academy of Family Physicians draws the line the same way, noting that DPC practices "do not accept insurance" while concierge practices "may continue to accept insurance plans." One question separates three business models that otherwise sound identical in a brochure.

Run all three through it:

• Traditional: bills your insurer. No membership fee.
• Concierge: bills your insurer and also charges a membership fee.
• Direct primary care: charges a membership fee and bills no one.

That single axis predicts nearly everything downstream: how the practice handles Medicare, whether an HSA is in play, what happens to panel size, and how much administrative machinery sits between you and your physician. AAFP also observes that DPC practices serve "all income and demographic levels," while concierge practices tend to cater "to higher-income populations."

Here is how the three compare on the questions patients actually ask me.

Question	Traditional	Concierge	Direct primary care
Bills your insurer?	Yes	Yes, and charges a membership on top	No
You pay a membership?	No	Yes	Yes
Typical panel size	Measured panels of 1,266 (VA) to 2,033 (solo GP in England)	Estimates conflict: 900 to 1,000 (JABFM), 491 in one documented conversion (GAO), 100 to 425 (MedPAC interviews)	About 413 on average (AAFP)
Typical cost	Premiums, copays and deductible; no separate fee	$60 to $15,000 per year in 2005, about half at $1,500 to $1,999 (GAO); $1,000 to $50,000 reported in 2025 (KFF Health News)	About $98 per member per month nationally in 2024 survey data (DPC Alliance)
Still need insurance?	It is the insurance	Yes	Yes, for everything outside primary care
HSA-eligible?	Only through a qualifying high-deductible plan	Generally no, because the practice also bills insurance	Does not disqualify you as of 2026 if the fee is $150 or less monthly for one person (IRS Notice 2026-5)

What each model actually costs

Direct primary care averaged roughly $98 per member per month nationally, according to 2024 survey data from the DPC Alliance covering 465 practices. Concierge fees are older and far wider. The GAO found a range of $60 to $15,000 a year in 2005, with about half of practices charging $1,500 to $1,999.

Regional spread in that 2024 survey data was substantial. The West averaged $113.28 per member per month, the Northeast $110.44, the South $98.38 and the Midwest $80.36. Setting mattered too: rural practices averaged $81.56, suburban $99.78 and urban $110.00. Roughly 76.4% of practices tier pricing by age, so a 62-year-old and a 24-year-old rarely pay the same amount.

Concierge pricing today is harder to pin down, because no agency tracks it. KFF Health News reported in April 2025 that annual concierge fees now run from $1,000 to $50,000. You will find confident "average concierge fee" figures circulating online. I could not trace any of them to a primary source, so I will not repeat them.

One structural difference outweighs the sticker price. A concierge fee sits on top of premiums, copays and deductibles. A DPC fee replaces primary care billing entirely, though you still owe premiums for everything else. I broke down what care costs when you pay cash in this look at healthcare pricing without insurance.

How many patients does your doctor actually have?

Fewer than the famous number suggests. Raffoul and colleagues, writing in the Journal of the American Board of Family Medicine in 2016, found the 2,500-patient benchmark "seems to arise in the literature anecdotally, without a basis in research." Measured panels ran lower: 1,266 at the VA, 1,490 at Group Health, 1,751 at Kaiser and 2,033 for solo GPs in England.

Those are real counts, not folklore. The takeaway is that "my doctor has 2,500 patients" is a number people repeat without checking, while the research puts most primary care panels somewhere between 1,200 and 2,000.

Retainer panels are smaller, but the published estimates disagree badly and you deserve to know that. JABFM puts concierge panels at 900 to 1,000. The GAO documented one physician who went from 2,716 patients to 491. Physicians interviewed for the MedPAC report carried 100 to 425, down from over 2,000 before converting. AAFP reports an average DPC panel near 413.

Which figure is correct? Probably all of them, depending on which of the three models a practice runs. A hybrid that still bills insurance needs volume to survive. A fee-for-care practice does not. If panel size matters to you, ask the practice for its actual number instead of trusting a category average.

The market is growing, and independent ownership is shrinking

Concierge and DPC sites grew 83.1% between 2018 and 2023, from 1,658 to 3,036, according to Zhu and colleagues in Health Affairs (December 2025). Clinicians rose 78.4%, from 3,935 to 7,021. That is the headline everyone quotes. The subplot is more interesting.

Over the same period, independent ownership fell from 84.0% to 59.7%, while corporate-affiliated practices grew 576%. The model began as a way for physicians to step outside corporate medicine. A growing share of it is now corporate-owned. Whatever you make of that, it changes what "independent doctor" means when a practice uses the phrase in an ad.

Arizona law: what a DPC agreement is and is not

Arizona settled this in 2019. SB 1105 replaced Title 44, Chapter 11, Article 25 of the Arizona Revised Statutes (A.R.S. sections 44-1799.91 through 44-1799.96), and the language is blunt: direct primary care agreements "are not insurance." That sentence is why a DPC practice is not regulated by the Department of Insurance, and why it cannot function as your coverage.

The statute also imposes real consumer protections. The agreement must be in writing. Either party may terminate on 30 days' written notice. No more than 12 months of fees may be collected in advance. A provider may not decline or discontinue a patient solely because of health status, and may not charge different fees for comparable services based on health status or gender.

Two provisions get overlooked. The agreement must prohibit the provider from submitting a claim to your health insurer, which is the legal expression of the axis this entire article turns on. And the fee may be paid by an employer or another third party, which is how self-funded employers fold DPC into a benefits package.

Arizona also requires specific language in every agreement. Read it before you sign anything:

"NOTICE: THE ORGANIZATION FACILITATING THE DIRECT PRIMARY CARE AGREEMENT IS NOT AN INSURANCE COMPANY AND THE DIRECT PRIMARY CARE COMPANY GUIDELINES AND AGREEMENT ARE NOT AN INSURANCE POLICY... REGARDLESS OF WHETHER YOU RECEIVE TREATMENT FOR HEALTH CARE ISSUES THROUGH THE DIRECT PRIMARY CARE AGREEMENT, YOU ARE ALWAYS PERSONALLY RESPONSIBLE FOR PAYING ANY ADDITIONAL HEALTH CARE EXPENSES YOU MAY INCUR."

The legislature wrote that in capital letters for a reason. A membership is not coverage.

Can you pay a DPC membership with an HSA?

As of 2026, yes, within limits. IRS Notice 2026-5 provides that for months beginning after December 31, 2025, enrollment in a qualifying direct primary care service arrangement no longer disqualifies you from contributing to a health savings account. The fee cannot exceed $150 per month for one person, or $300 for more than one.

Qualifying practitioners are physicians in family medicine, internal medicine, geriatric medicine or pediatric medicine, plus nurse practitioners, clinical nurse specialists and physician assistants. The notice excludes three things from "primary care services": procedures requiring general anesthesia, prescription drugs other than vaccines, and laboratory services not typically administered in an ambulatory primary care setting.

Now the fine print I almost never see mentioned. The sole compensation for care provided under the arrangement must be the fixed periodic fee. A practice that charges a membership and also bills for visits does not meet the definition, which quietly excludes most concierge arrangements from this rule.

One caveat matters enormously for older readers. Anyone enrolled in Medicare cannot contribute to an HSA at all, so this change is largely irrelevant if you are 65 and enrolled. You may still spend down an existing balance. Confirm your own situation with a tax professional rather than with your doctor.

Do you lose Medicare if your DPC doctor opts out?

No, and this is the most common misunderstanding I encounter. About 80.7% of DPC physicians have opted out of Medicare entirely, per DPC Alliance survey data. Opting out means the physician bills Medicare for nothing. It does not mean you leave Medicare, and it does not touch your Part A, Part B or Part D benefits.

The mechanics are straightforward. A physician who opts out files an affidavit that renews automatically every two years until revoked, and signs a written private contract with each Medicare beneficiary they treat. The decision is all-or-nothing and applies nationwide. There is no partial version.

Here is the part retirees consistently get wrong. When your DPC physician has opted out, only the membership sits outside Medicare. Medicare still covers the labs, imaging, specialist visits, hospitalizations and prescriptions your DPC physician orders or refers you to. What Medicare will not do is reimburse the membership fee itself. I walk through the details in this guide for Prescott retirees on DPC and Medicare.

There is also a reason concierge practices structure fees the way they do. An HHS Office of Inspector General alert issued March 31, 2004 warned that a participating physician charging extra fees for already-covered services "abuses the trust of Medicare patients by making them pay again for services already paid for by Medicare." That is precisely why concierge retainers are typically built around a non-covered annual physical.

Does DPC actually save money?

Probably not overall, and I would rather tell you that than sell you something. The only rigorous actuarial evaluation of DPC, conducted by Milliman for the Society of Actuaries in May 2020, used risk-adjusted longitudinal claims from one mid-sized self-funded employer over two years. Net employer cost rose 1.3% once the membership fee and deductible waiver were counted.

The utilization findings, though, were genuinely strong. Overall demand for health care services fell 12.64% and emergency department usage fell 40.51%, both statistically significant. Inpatient admissions fell 19.90%, but that result was not statistically significant, and anyone quoting it without saying so is misleading you.

So two things are true at once. People used meaningfully less care, especially emergency care, and the employer still spent slightly more. One employer over two years is not the final word, but it is the best evidence in existence. If a practice promises DPC will lower your total health spending, ask which study they are citing.

The honest reason to choose this model is access and relationship, not arbitrage. The same analysis found DPC visits average about 40 minutes, against roughly 13 to 16 minutes in a traditional office. That time is the product.

Does either model improve health outcomes?

The evidence is thinner than the marketing. A 2025 systematic review of concierge medicine in the American Journal of Medicine by Rylands and colleagues concluded that "limited evidence exists to confirm the benefits of concierge medicine on patient clinical outcomes," although patient satisfaction was significantly increased. Satisfaction and outcomes are not the same measurement.

Physician experience follows a similar pattern. In the Milliman report, 99% of DPC physicians reported better overall satisfaction while only 34% reported better earnings. Most of us did not do this to get rich. We did it to stop practicing medicine in twelve-minute increments.

Does longer visit time eventually show up as better blood pressure control or fewer complications? I believe it does, and I have watched it happen with individual patients. But belief is not evidence, and the published literature has not settled the question. You should know that before you pay anyone a membership fee.

When DPC Is the Wrong Choice

DPC is a poor fit for more people than my corner of medicine likes to admit. Arizona law is explicit that these agreements are "not insurance," so a membership sits alongside coverage rather than replacing it. If you cannot comfortably carry both, the math does not work. Five situations where I would tell you not to join:

You already have a rich, low-deductible employer plan

If your plan covers primary care at a $20 copay with no deductible, you are already close to free at the point of care. Adding a membership means paying twice for the same category of service. The access and visit length may still be worth it to you, but be clear that is what you are buying.

You cannot afford both a premium and a membership

This is the scenario that worries me most. If a membership fee would push you toward dropping insurance, do not join. Primary care handles a great deal, but it does not handle an appendectomy, a stroke or a cancer diagnosis. The Arizona notice says it plainly: you remain personally responsible for any additional health care expenses.

Your care is dominated by specialists

If you are in active oncology treatment, on dialysis, or managing advanced heart failure, primary care access is not your bottleneck. Your oncologist or nephrologist is already coordinating most of your care, and a membership adds a monthly fee for a role that is largely filled. Some patients still want a quarterback. Many genuinely do not need one.

You are enrolled in AHCCCS or Medicaid

Primary care under AHCCCS costs you nothing. Paying a monthly fee to duplicate a $0 benefit is hard to justify on financial grounds. If access is your real problem, changing plans or clinics is usually the cheaper fix.

You are thinking about swapping insurance for a health care sharing ministry

Read this one twice. Michigan's Department of Insurance and Financial Services states that sharing ministries "are not considered health insurance because they do not assume any risk, and because the ministries are not legally or contractually obligated to pay health care costs." No law requires them to pay a claim, and state insurance regulators generally cannot help you if they decline.

Plenty of members report good experiences, and that is not the point. The point is that you would be trading a legal obligation for a voluntary one. Pairing DPC with a sharing ministry is common. Just know exactly what you are holding before a large claim arrives.

So how should you decide?

Start with the sorting question and work outward: does this practice bill your insurer? Then ask three follow-ups. What is the actual panel size? What does the fee cover and exclude, in writing? And given that these practice sites grew 83.1% from 2018 to 2023 while independent ownership fell to 59.7%, who owns this practice?

My honest summary, from inside the model: DPC buys you time and access, not savings. The Milliman evidence shows real drops in utilization alongside a small increase in total cost. Concierge buys amenities layered on top of insurance you are still using. Traditional primary care remains the right answer for plenty of well-insured people.

If you are weighing this in Prescott and want a straight answer about whether membership medicine fits your situation, including the cases where it clearly does not, you are welcome to reach out with your questions. I would rather talk someone out of joining than watch them join for the wrong reason.