Quick Answer
Direct primary care and concierge medicine both use a membership model to give patients a closer relationship with their provider. The main difference in direct primary care vs. concierge medicine is billing. Direct primary care usually charges a flat periodic fee that covers primary care services without billing insurance for them. Concierge practices typically charge a membership fee and also bill insurance for visits. Details vary by practice, so it is worth asking exactly what is included.
Who this is for: adults comparing membership-based primary care options and trying to understand how they differ from each other and from traditional practices.
What Direct Primary Care Is
In direct primary care, patients pay a recurring membership fee, often monthly, directly to the practice. The fee covers a defined set of primary care services, and the practice generally does not bill insurance for those services.[1] Because practices are not built around insurance billing, they often keep smaller patient panels, which can allow longer visits and easier communication with the provider.
Direct primary care is not insurance. Members typically still need health insurance for hospital care, emergencies, specialists, imaging and other services outside primary care.
What Concierge Medicine Is
Concierge medicine also uses a membership or retainer fee, which is often paid annually. In many concierge practices, the fee covers enhanced access or extra services, while visits and tests are still billed to insurance. Concierge fees vary widely, and some practices offer extensive services such as comprehensive annual physicals.
Key Differences at a Glance
- Billing: direct primary care usually does not bill insurance for covered primary care services; concierge practices often bill insurance in addition to the membership fee
- Fee structure: direct primary care is often a flat monthly fee; concierge fees are often annual
- What is included: both vary by practice, so review the membership agreement carefully
- Insurance: with either model, you will usually still want insurance for care outside the practice
Both models aim to give patients more time and continuity than a typical high-volume practice, but each practice defines its own services and access.
Direct primary care and concierge medicine differ mainly in how they bill.
Questions to Ask Any Membership Practice
- What exactly does the membership fee cover?
- Which services cost extra, such as labs, procedures or medications?
- How do I reach the provider between visits, and how quickly can I expect a reply?
- Are visits in person, virtual or both?
- What happens if I need a specialist, imaging or hospital care?
- Are there age requirements or services the practice does not provide?
- Does the practice bill insurance or Medicare for anything?
- How do I cancel, and is there a minimum commitment?
Direct Primary Care at Lake Forest Regenesis
Lake Forest Regenesis offers a Direct Primary Care membership for adults with Allana as your primary care provider. Membership covers primary care services within the clinic’s scope, with visits in the office or by televisit as the schedule allows, and replies to messages and calls within one business day. Membership is paid directly to the clinic, the clinic does not bill Medicare, and some services are not included, so it is worth reviewing the details to see whether the model fits your needs.
When to See a Provider
Membership primary care is not a substitute for emergency care. Call 911 or go to the nearest emergency room for chest pain, trouble breathing, signs of stroke, severe bleeding or other emergencies.
Comparing membership care options? Talk with us about how Direct Primary Care works at Lake Forest Regenesis and whether it fits.
Frequently Asked Questions
Is direct primary care the same as concierge medicine?
No. Both use memberships, but direct primary care generally does not bill insurance for covered services, while many concierge practices bill insurance in addition to their fee.
Do I still need health insurance with a membership practice?
Usually, yes. Insurance covers care outside primary care, such as hospital stays, emergencies, specialists and imaging.
Which model is less expensive?
It depends on the practice, what is included and how you use care. Comparing what each fee covers is the best way to decide.
Can I switch from a traditional practice to direct primary care?
Yes. You can usually transfer your records and establish care with the new provider.
References
- American Academy of Family Physicians. Direct primary care. Read the policy
This article is for general education and is not a substitute for individual medical advice. See our medical disclaimer.
