Concierge Medicine As a Replacement for Insurance

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Last updated on July 22, 2019 Comments: 11

Although I’ve mostly figured out how to get my financial life in order, other aspects of my life still need work. For example, I’ve visited a physician only a few times over the past ten years. I should be seeing a doctor about once a year if I were to listen to the typical medical advice. With my medical insurance provider changing four times in the last two years, it’s been even more difficult for me to nail down some consistency in medical coverage. But that’s just an excuse.

As an independent contractor, it’s up to me to find and pay for medical insurance — and this isn’t cheap in the state of New Jersey. An increasing number of people in my situation — as well as those who do have employer-provided insurance — are turning towards concierge medicine.

The type of care provided by doctors who follow the concierge model is more like the medical care of the past: doctors have fewer patients and build personal relationships, make house calls, and in many cases, earn a better living than they would when dealing with insurance companies.

For a monthly retainer fee, a patient can have access to their family physician at any time.

There are great benefits to this model, but it can’t replace insurance completely, particularly not for people who aren’t rich. Concierge medicine has been a service consumed by the wealthy, but as it has been growing in popularity, the idea is increasingly gaining traction among those who are not as flushed with cash. The concierge model is not a replacement for insurance. It’s fine when all you need to deal with is a physician, but specialists can cause problems.

Treatment not handled by a physician can be expensive. This is how people without insurance can find themselves in debt that they can’t overcome. One operation can cost hundreds of thousands of dollars without insurance, and concierge medicine does nothing to solve that problem. It cannot be a full replacement for insurance — or it can be, until a patient needs anything more than basic medical care.

The career situation for physicians is difficult, and moving from insurance to a concierge practice is one way for their industry to survive and thrive. Many of the best medical students turn towards a specialty because the compensation is so much better, as a result of the way insurance companies reimburse doctors for services. Compensation is not just the simple issue of supply and demand, but that has something to do with it as well.

Society still needs primary care physicians even though they don’t make as much money as specialists for the most part. To justify the ever-increasing cost of medical school, doctors need to seek higher compensation. A concierge model can increase the annual income of a practice. For the patient, however, the typical concierge medicine approach is incomplete. Insurance is still necessary — though perhaps an insurance plan that includes only catastrophic coverage — because once you need a specialist, without insurance, you’ll need to pay for your care out of your pocket.

Would you be willing to pay a monthly retainer fee for more direct access to your physician? How would you then cover yourself for any procedure or treatment your physician might not be able to handle? Is concierge medicine still only a reasonable health care option for the wealthy? With the Affordable Care Act, designed to encourage insurance for all citizens, is concierge medicine a viable option?

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Article comments

Anonymous says:

Will a concierge doctor model qualify on the Affordable Care Act under the coverage requirements or will i still be required to have Insurance for those requirements as well?

Anonymous says:

The concierge model seems to be a good option for all of your primary care. I actually just read an article about it in Bloomberg Businessweek. I would definitely entertain the idea of this. The availability and ease of contact makes it worth it for me. I am not sure how I would do it for my kids, as they see a very good pediatrician. Or, at least they did. They see him once in a great while and almost always see some other doctor in his office. Even with the concierge plan you would need insurance for any specialists or other non-primary care procedures.

Anonymous says:

Our doctor converted to the concierge model and we decided to go that route to stay with him. We pay an annual retainer. My last physical lasted for almost three hours and most of it was directly with the doctor either in consultation in his office or during the actual exam. Additionally we have his cell number for 24/7 access if needed. A bit pricey, but my wife and I feel it is worth it. We also have a high deductible PPO plan with an HSA through my wife’s employer. We still have 2 (of our 3) kids as dependents.

Anonymous says:

I guess I don’t really understand the advantage of this, especially when you would need other insurance for anything not done by your own doctor. My wife and I have had the same family doctor for 27 years. We’ve been through 3 different employer-provided insurance companies, one military insurance and now Medicare. Nothing in our relationship has ever changed because of the particular insurance used – at least from our point of view. Although he doesn’t make house calls, with the electronic communications of today any question/response needed is satisfied pretty quickly. By-the-way, since I don’t “see” this type of thing often the first example of “concierge” doctor that pops into my head is the one who worked for Michael Jackson …… I’ll pass!

Anonymous says:

If you don’t go to the doctor a lot, the EPO’s offered in NJ can work. They are about the cheapest plans available—–still not dirt cheap but far below all others. With a concierge doctor, who pays for the medical tests that they may order? Just one MRI can set you back a few grand. And frankly, I’d rather go to a Nurse Practitioner if I could.

Anonymous says:

I would! I’m not sure how much more it would cost than actual decent coverage via self insurance, though — that is crazy expensive.

Anonymous says:

I know a few rcih people that use a concierge doctor, and love watching the show “Royal Pains’ which is about a concierge doctor in the Hamptons. I would love to have direct access to just chat about and learn from my doctor. I think it’s a great idea, but I do agree, it’s not a full replacement for insurance. I would opt for a hybrid and do both 🙂

Anonymous says:

God yes. I wish it were within reach of my income level. I have a doctor friend that I suggested getting into just this field almost a decade ago, but he didn’t think it was such a great concept.

Anonymous says:

I like the idea of concierge medicine, but as it is now, there are too many gaps. You could get insurance to cover a major medical event, but what if you needed to go to a specialist? Chances are your insurance wouldn’t cover it, nor would your concierge medicine.

Anonymous says:

“doctors have fewer patience”


Anonymous says:

I have PPO insurance through work. As a teacher, I will have insurance in retirement too. I am very selective with my doctors. I refer to them as doctors’ doctors. These are the guys doctors go to when they are sick. It helps that my wife is an RN too. I ask a lot of questions, it is my way to determine the quality of work. Doctors are no different than other service people. You want a referral and you should ask a lot of questions.