Concierge medicine and direct primary care are often mentioned in the same breath. Both involve paying a doctor’s office a concierge fee, and both promise more time and easier access. Underneath, they are built differently, and the difference affects how you pay for care, how insurance fits in, and even how your health savings account can be used.

Here is the short version:

  • Concierge medicine usually charges a concierge fee and also bills your insurance, including Medicare, for visits, labs and tests.
  • Direct primary care, often called DPC, usually charges a monthly fee that covers primary care services, and the practice generally does not bill insurance for them.

These are general patterns, not legal definitions. Individual practices vary, so always read the agreement before you sign.

How insurance fits in

In a concierge practice, insurance does much of the same work it does at any doctor’s office. Visits and tests are billed, and your copays and deductibles apply. The concierge fee is separate. Medicare, for instance, does not cover concierge fees, and a doctor who accepts assignment cannot charge extra for Medicare-covered services.

Many DPC practices take insurance out of primary care altogether. The monthly fee replaces billing for routine office care, which keeps paperwork low. Patients in a DPC practice still need insurance for hospital stays, specialists, imaging and other care the practice does not provide.

How the fees are structured

DPC fees are typically charged monthly and are meant to cover a defined set of primary care services. Concierge fees are more often annual, and what they cover varies widely: some include an extended physical or a wellness program, while others mainly secure access to the doctor. Because concierge practices still bill insurance for care, the fee is paying for something different than a DPC fee is.

The 2026 HSA rule applies to direct primary care

Starting January 1, 2026, a federal law passed in 2025 changed how health savings accounts treat direct primary care. Under IRS guidance in Notice 2026-5, people enrolled in a qualifying direct primary care service arrangement can stay eligible to contribute to an HSA, and can pay those fees from the account, as long as the fees are no more than $150 a month for one person or $300 a month when the arrangement covers more than one person. The IRS summarized the changes in a news release.

That rule was written for direct primary care. A concierge practice that bills insurance for care, or charges more than those limits, likely does not fit the definition. The IRS has not issued a ruling on concierge fees in general. If this matters to you, ask a tax advisor before you count on using HSA money. We go into more detail in Can you pay concierge fees from an HSA or FSA?

What Florida law says

Florida addresses these arrangements in section 624.27 of the Florida Statutes, which covers direct health care agreements between patients and providers. The statute says such an agreement is not insurance, so it is not regulated by the state the way a health plan is. That is one more reason to read any membership agreement carefully and to keep your regular health coverage in place. Medicare makes a similar point on its concierge care page, noting that state laws and consumer protections may apply and that your state’s insurance department or consumer protection office can help with questions.

Which model fits which person

People who already have Medicare or employer coverage often prefer a concierge practice because their insurance keeps working for visits and tests, and the membership adds time and access on top. People with high-deductible plans, or without much use for insurance in primary care, sometimes find DPC simpler.

Neither model replaces health insurance for the care a primary care office cannot provide. If you are weighing the options, concierge vs. traditional primary care lays out another useful comparison, and what is concierge medicine covers the basics.

Where Legacy Medical stands

Legacy Medical is a Concierge Internal Medicine practice. We bill insurance, including Medicare, Aetna, Cigna and BlueCross BlueShield, for visits, labs and tests, and members pay an annual concierge fee that is not billed to insurance. Members are seen the same or next business day and can reach the practice by phone at any hour. Our insurance and fees page explains the details.

If you would like to understand how it would work with your own coverage, start with a complimentary meet and greet with Dr. Shtern. You are welcome to bring your insurance card and your questions.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.