What Is the Difference Between DPC and Concierge Medicine?
Direct primary care (DPC) and concierge medicine both charge patients a recurring membership fee for closer access to their own primary care physician. The biggest difference is insurance. DPC practices typically do not bill insurance, so a monthly fee covers most everyday primary care, while concierge practices often keep billing insurance for covered visits and charge a separate, usually higher, annual fee for extra access and an in-depth yearly exam.
That one difference shapes almost everything else, from what the fee pays for to how each model handles Medicare and health savings accounts. Both models exist for the same reason, which is that physicians and patients want more time together than a crowded fee-for-service schedule allows. They simply take different routes to get there.
This guide puts the two models side by side, with every number linked to its source, then walks through how a patient might choose and how a physician might decide which kind of practice to open in 2027.
DPC vs Concierge Medicine at a Glance
The table below summarizes the most common setup for each model. Individual practices vary, and some hybrid practices mix features of both, so treat this as the typical pattern rather than a rule.
| Direct primary care (DPC) | Concierge medicine | |
|---|---|---|
| How the fee is usually charged | Monthly membership | Annual membership, often payable monthly or quarterly |
| Typical fee | $50 to $100 a month, per the AAFP | Wide range, from about $199 a year to $10,000 or more a year, per KFF Health News |
| Bills insurance? | Typically no | Often yes, for covered services |
| What the fee covers | A broad range of primary care services | Extra access and services insurance doesn't pay for, often centered on an in-depth annual exam |
| Average panel size | 504 patients in 2025, the AAFP's average across all its survey respondents (53% in DPC) | MDVIP physicians limit practices to around 600 patients |
| Medicare | Physicians who charge Medicare patients privately for covered services opt out (2-year periods) | Many stay enrolled and charge the fee only for non-covered services |
| HSA from 2026 | Qualifying arrangements keep HSA eligibility within the IRS fee cap and can be paid from an HSA | A membership where the practice also bills insurance for that care doesn't fit the DPC definition |
| Usually paired with | A high-deductible, catastrophic or wraparound plan | The patient's existing insurance or Medicare |
| Who it suits | People who want everyday primary care for one predictable fee | People who want to keep insurance-billed care and add more time and access |
The rest of this page explains each row, with the source behind it.
How Much Does DPC Cost Compared With Concierge Medicine?
DPC fees are published, fairly consistent and usually monthly. Concierge fees vary much more by region, brand and what the membership includes.
The AAFP's direct primary care page says monthly membership fees in DPC practices typically range from $50 to $100.
An earlier AAFP Family Practice Management article cited a 2017 AAFP data brief showing most DPC practices charged $50 to $75 a month for individual adults and $75 to $175 for families.
For concierge medicine, there is no single national average that's measured the same way. KFF Health News reported in July 2024 that annual fees range from $199 for Amazon's One Medical to low four figures for companies like MDVIP and SignatureMD, and up to $10,000 or more at top-branded practices.
MDVIP, a national concierge network of more than 1,300 affiliated doctors, says on its own site that its fee varies by location and physician, can usually be paid quarterly, semi-annually or annually, and is listed on each doctor's profile in its doctor search. If you are pricing a specific practice, that profile is the number to trust.
For DPC owners setting a price, our guide on how much to charge for a DPC membership goes deeper on fee tiers, family pricing and what to include.
Do DPC and Concierge Practices Bill Insurance?
This is the clearest dividing line between the two models. The AAFP says that DPC practices typically do not accept insurance or participate in government programs, and that patients are often advised to carry a high-deductible or wraparound plan for emergencies, specialists and hospital care.
Concierge practices, by contrast, may continue to accept insurance and government programs and bill insurers for covered services, according to the same AAFP page. The membership fee sits on top of that billing and pays for things insurance does not, such as extended access and a more in-depth annual exam.
That difference changes the economics of each practice. A DPC practice lives almost entirely on membership revenue, so its fee has to cover most of the care it delivers. A concierge practice keeps its insurance revenue and uses the membership fee to fund a smaller panel and the extra time that comes with it.
How Many Patients Does Each Model See?
Both models run much smaller panels than a typical insurance-based primary care practice, which is the point of both.
The AAFP reports an average panel of 504 patients in 2025, up from 402 in 2024, across all its survey respondents, 53% of them practicing in DPC. Your own cap may sit above or below that average, and our post on DPC break-even panel size walks through how fee and overhead decide the number you actually need.
On the concierge side, MDVIP says its affiliated doctors limit their practices to around 600 patients, compared with an average of 2,300 patients in a traditional primary care practice. KFF Health News cites Concierge Medicine Today's estimate that about 5,000 to 7,000 physicians and practices provide concierge care in the United States.
Medicare Rules for DPC and Concierge Practices
Medicare is where the two models differ most in practice, and it weighs heavily for physicians when choosing.
Concierge practices that stay enrolled in Medicare
Many concierge practices remain enrolled in Medicare and keep billing it for covered visits. Medicare.gov states that Medicare does not cover concierge membership fees, that the patient pays all costs for non-covered services including the membership fee, and that doctors who accept assignment cannot charge extra for Medicare-covered services.
The HHS Office of Inspector General made the same point in a 2004 alert on added charges for covered services. In practice, this means a concierge membership for Medicare patients has to be built around services and access Medicare doesn't already pay for, and practices usually have that structure reviewed by a healthcare attorney.
Do you have to opt out of Medicare for DPC?
A DPC physician who wants to charge Medicare patients a private fee for services Medicare would normally cover has to opt out of Medicare. Under 42 CFR 405.405, that means filing an opt-out affidavit and signing a private contract with each Medicare beneficiary.
The opt-out period is defined in 42 CFR 405.400 as two years, and it renews for each successive two-year period unless the physician properly cancels it. When the first period starts depends on the physician's Medicare status, under the timing rules in 42 CFR 405.410. A nonparticipating physician's opt-out begins the date the affidavit is signed, provided it is filed within 10 days after the first private contract is signed, while a participating physician can opt out only at the start of a calendar quarter, with the affidavit submitted at least 30 days before that quarter begins. That makes opting out a real commitment, so it's worth deciding early how many Medicare-age patients you expect and whether you'll serve them inside the membership.
Our 2027 guide to starting a DPC practice covers the opt-out paperwork alongside the rest of the launch checklist.
Can You Use an HSA for DPC or Concierge Medicine?
The rules changed on January 1, 2026. Section 71308 of the One Big Beautiful Bill Act, Public Law 119-21, signed July 4, 2025, says a qualifying direct primary care service arrangement no longer counts as a health plan that blocks HSA contributions, and the fee can be paid from an HSA.
For 2027, IRS Rev. Proc. 2026-24 keeps the fee cap at 150 dollars a month for one person and 300 dollars a month for an arrangement covering more than one person.
The definition is narrow. IRS Notice 2026-5 explains that the arrangement must cover only primary care from primary care practitioners, and the fixed periodic fee must be the sole compensation for care under it. A concierge membership where the practice also bills insurance for the care it provides doesn't fit that definition, so the new DPC rule doesn't make it HSA compatible.
That doesn't settle every question about concierge fees and HSAs. MDVIP says its fee may be reimbursable from a flexible spending or health savings account and suggests checking with your plan administrator, while KFF Health News reported that concierge fees typically can't be paid that way. If this matters to you, ask your plan administrator before you join. For the full detail on caps, excluded services and employer-paid memberships, see our DPC HSA rules for 2027.
State Laws for DPC and Concierge Practices
Many states have passed laws that say a DPC membership is not insurance, which keeps DPC practices out of insurance regulation as long as they follow the state's conditions. The details vary a lot, from required contract language to limits on what the fee can cover. Our state-by-state guide to direct primary care laws lists what each state requires.
Concierge practices that keep billing insurance are generally shaped more by their payer contracts and Medicare enrollment than by DPC statutes, though state consumer protections can still apply, as Medicare.gov notes. Either way, a short review with a healthcare attorney in your state is money well spent before you sign your first member.
Is Concierge Medicine Worth It? How Patients Can Choose
Neither model is better in general. They solve slightly different problems, and the right one depends on how you use healthcare today.
Concierge medicine tends to suit people who:
- want to keep their current insurance or Medicare paying for visits, labs and procedures
- value an in-depth annual exam and extended preventive screening
- want faster appointments and direct access to a physician while staying in-network for everything else
Direct primary care tends to suit people who:
- want one predictable monthly fee that covers most everyday primary care
- are pairing it with a high-deductible, catastrophic or health-sharing plan for bigger events
- want an HSA-compatible arrangement under the 2026 rules
- are self-employed or covered by an employer that offers DPC as a benefit
A simple way to compare is to list the visits, messages and labs you used last year and price them under each option, including your insurance premium and deductible. The Tabflows DPC Finder lists DPC practices across the country if you want to see local fees and services, and most concierge practices publish their fee on request or on their physician profile.
The research on outcomes is still growing for both models. A 2025 systematic review in The American Journal of Medicine found that evidence on clinical outcomes for concierge medicine is still limited, though the model reports notably higher patient and physician satisfaction.
DPC or Concierge? How Physicians Can Choose Which Model to Open
For physicians, the choice usually comes down to your current patients, your payer mix and how much billing you want to keep running.
Concierge medicine often fits physicians who:
- have a large established panel, many on Medicare, who want to keep their insurance-billed care
- want to keep insurance revenue while shrinking the panel
- prefer a membership built around a comprehensive annual exam and extended access
- are open to joining a national network that provides marketing, conversion support and operations
Direct primary care often fits physicians who:
- want to step away from insurance billing, coding and prior authorization work
- are comfortable with membership fees as the main source of revenue
- plan to serve working-age adults, families and employer groups
- want the simplest possible back office and the new HSA compatibility as a selling point
Converting an existing insurance practice is possible with either model. Our guide to converting a practice to direct primary care covers how physicians tell patients, set a fee and plan for the panel they keep, and how much it costs to start a DPC covers the opening budget.
Whichever model you choose, a smaller panel means each patient expects more follow-through, and the work tends to pile up between the EHR, the billing system and the patient messaging inbox. Tabflows is a dedicated tech team that connects the tools a clinic already uses, so follow-ups, tasks and patient context live in one place instead of across three apps.
The Bottom Line
DPC and concierge medicine share a goal of more time with fewer patients, and both have helped physicians practice the way they want to. DPC typically drops insurance and charges a lower monthly fee for most primary care, while concierge medicine typically keeps insurance and charges a higher annual fee for extra access and a deeper yearly exam.
For patients, the right choice depends on whether you want to keep insurance-billed care as your foundation. For physicians, it depends on your panel, your Medicare patients and how much billing you want to carry into 2027. Start with the pillar guide on how to start a DPC practice if direct primary care is the direction you're leaning.
FAQs
What is the difference between direct primary care and concierge medicine?
Both charge a recurring membership fee for closer access to a primary care physician. The main difference is insurance. Direct primary care practices typically do not bill insurance at all, so the monthly fee is the practice's main income and covers a broad set of primary care services. Concierge practices often stay in insurance networks and keep billing insurance for covered visits, with the membership fee paying for extras such as extended access and an in-depth annual exam. The AAFP describes DPC fees as low and monthly and concierge fees as higher and usually annual.
How much does DPC cost compared with concierge medicine?
DPC fees are usually monthly and fairly consistent, while concierge fees are usually annual and vary much more by region, brand and what the membership includes. MDVIP says its fee varies by location and physician and is listed on each doctor's profile. The AAFP says DPC monthly membership fees typically range from $50 to $100. KFF Health News reported annual concierge fees from $199 for Amazon's One Medical to low four figures for networks such as MDVIP and SignatureMD, and $10,000 or more at top-branded practices.
Do concierge doctors take insurance?
Often, yes. The AAFP notes that concierge practices may continue to accept insurance and government programs and bill insurers for covered services. The membership fee is separate and is generally not covered by insurance. Medicare says it does not cover concierge membership fees, and doctors who accept assignment cannot charge extra for Medicare-covered services.
Does a DPC doctor have to opt out of Medicare?
A physician who wants to charge Medicare patients privately for services Medicare would normally cover has to opt out of Medicare by filing an affidavit and signing a private contract with each Medicare patient. Under 42 CFR 405.400 the opt-out period is two years and renews automatically unless the physician properly cancels it. Concierge practices that stay enrolled in Medicare follow a different rule, charging the membership only for services Medicare does not cover.
Can I use my HSA for DPC or concierge medicine in 2027?
Since January 1, 2026, a qualifying direct primary care arrangement no longer blocks HSA contributions, as long as its fees stay within the IRS monthly cap (150 dollars for one person or 300 dollars for more than one person in 2027). Its fee can be paid from an HSA even above the cap, though enrollment in a membership over the cap stops new contributions while you are enrolled. IRS Notice 2026-5 says the fixed periodic fee must be the sole compensation for care under the arrangement, so a membership where the practice also bills insurance for that care does not fit the definition. MDVIP says its fee may be reimbursable from an FSA or HSA and advises checking with your plan administrator.
Is concierge medicine worth it?
It depends on what you want to keep. Concierge medicine suits people who want to stay with insurance-billed care, often including Medicare, and add longer visits, faster access and an in-depth annual exam on top. Direct primary care suits people who want a lower monthly fee that covers most everyday primary care, often paired with a high-deductible or catastrophic plan for everything else. Comparing what each membership includes against your own visit history is the clearest way to decide.