What Medicare says
Medicare.gov describes concierge care as a doctor or group charging a membership fee before they'll see you. Its rules:
- Medicare doesn't cover the membership fee.
- Doctors who offer concierge care must still follow all Medicare rules.
- A doctor who accepts assignment can't charge you extra for Medicare-covered services, so the fee can't include extra charges for items or services Medicare usually covers.
- The exception is an item or service Medicare won't pay for. Then the doctor must give you a written Advance Beneficiary Notice of Noncoverage (ABN) listing the services and why Medicare may not pay.
- A doctor who doesn't accept assignment can charge up to the 15% limiting charge for Medicare-covered services. Any Medicare doctor can charge for services Medicare doesn't cover, and you pay all costs for those, including the membership fee.
What Florida law adds: s. 624.27
Florida calls many of these arrangements "direct health care agreements." Under s. 624.27, the agreement is not insurance, and it must:
- Be in writing and signed by you and the provider.
- Describe what the monthly fee covers and list any fees for services it doesn't cover.
- Let either side cancel with at least 30 days' written notice.
- State its length and any automatic renewal.
- Refund fees paid in advance if the provider stops offering care for any reason.
- Say on the signature page, in contrasting color and 12-point type, that it is not health insurance and that the provider won't file claims with your insurance for services the agreement covers.
Medicare.gov lists "direct care" as another name for concierge care, and says doctors who offer it must still follow all Medicare rules. The Florida agreement doesn't change those rules for Medicare-covered services.
Before you sign
- Ask: "Are you enrolled in Medicare, and do you accept assignment?" If the doctor has opted out, Medicare pays nothing for their care except emergencies or urgent care.
- Ask for the list of what the fee covers, in writing, and compare it with what Medicare already covers, such as your yearly wellness visit.
- Keep seeing your doctor through Medicare if you don't sign. Medicare doesn't require you to join.
Questions about a Medicare bill: 1-800-MEDICARE (1-800-633-4227). More on finding doctors who accept Medicare in Florida. To review coverage options, you can request a call from a licensed insurance agent.
Related questions
Why won't some Florida doctors take new Medicare patients?
Opt-out, full practices and assignment.
How do I find a doctor who accepts Medicare?
Care Compare in four steps.
How does Medicare work in The Villages?
Three counties, three plan lists.
Sources
- Medicare.gov — Concierge care
- Florida Statutes — s. 624.27, Direct health care agreements; exemption from code
- eCFR — 42 CFR 405.425, Effects of opting out of Medicare
- CMS — Opt Out Affidavits
More questions in this guide
- Do I need Medicare Part B if I'm still working at 65 in Florida?
- Why won't some Florida doctors take new Medicare patients?
- How does Medicare work in The Villages, Florida?
- How do I find a doctor who accepts Medicare in Florida?
- How do I find a Spanish-speaking doctor who takes Medicare in Florida?
Part of the guide: Medicare in The Villages and Florida's 55+ communities · All questions
Frequently asked questions
Does Medigap or Medicare Advantage pay a concierge fee?
Medicare doesn't cover membership fees for concierge care. Medigap policies pay costs Medicare approves, so they don't pay the fee either. Check your Medicare Advantage plan's Evidence of Coverage, but don't assume it pays one.
Is a concierge agreement health insurance in Florida?
No. Under Florida Statutes s. 624.27, a direct health care agreement is not insurance and isn't regulated under the Florida Insurance Code. It must say on its signature page that it is not health insurance.
What if my concierge doctor has opted out of Medicare?
Then Medicare and Medicare Advantage plans don't pay for any of that doctor's services except emergency or urgent care, and you pay what your private contract says. You can check CMS's opt-out list by name.
Medicare in your Florida county
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