How to Start a Concierge Medicine Practice in 2027

How Do You Start a Concierge Medicine Practice?

You start a concierge medicine practice by choosing the model first (full concierge, hybrid concierge or direct primary care), then checking Medicare and state rules with a healthcare attorney, deciding whether to join an affiliation network or go independent, and giving your current patients several months of notice before the membership starts. Most concierge practices keep billing insurance and Medicare for covered visits and charge an annual fee for things those payers do not cover, such as extended access and a longer yearly exam. Converting usually means going from a traditional panel of a couple of thousand patients to a few hundred members.

This guide walks through each step for 2027, with the rules and numbers linked to their sources. It is a planning guide, not legal or tax advice, and the rules that matter most (Medicare assignment and your state's insurance law) are worth an hour with a healthcare attorney before you send a single patient letter.

What Is the Concierge Medicine Business Model?

A concierge practice charges patients a recurring membership fee, usually billed yearly, in exchange for a smaller panel and more access to the physician. In the most common version the practice still bills insurance and Medicare for covered visits, so the membership adds a second revenue stream on top of claims rather than replacing them.

KFF Health News reported in 2024 that concierge physicians typically limit their practices to a few hundred patients, compared with a couple of thousand for a traditional primary care doctor, so they can promise same-day or next-day appointments and longer visits. Many give patients their mobile number.

The model has grown well beyond solo physicians. The same KFF Health News report found large hospital systems such as Northwestern Medicine, Penn Medicine and Baptist Health offering concierge programs, and MDVIP, the largest affiliation network, says it now has more than 1,400 affiliated physicians caring for more than 400,000 patients.

Full Concierge vs Hybrid Concierge vs DPC

Before you price anything, decide which of the three membership models you are actually building. They look similar from the outside, but they differ on insurance billing, fee size and how the rules treat them. For a deeper side-by-side, see DPC vs concierge medicine.

The DPC panel figure comes from the AAFP's direct primary care page, which also notes that concierge practices may keep accepting insurance and government programs.

The same AAFP page says DPC fees are typically $50 to $100 a month.

What is a hybrid concierge model?

A hybrid concierge model keeps your traditional insurance practice running while offering a paid membership tier to the patients who want more. Non-members keep seeing you on the usual terms. It is a lower-risk way to test demand, but it asks more of your scheduling and your staff, because two groups of patients now have two different promises about access. It also needs the same care with Medicare rules as a full conversion, since a membership tier that seems to buy faster access to covered visits is the kind of arrangement the 2004 OIG alert below warns about.

Direct primary care

DPC practices usually step out of insurance billing entirely and charge a lower monthly fee that covers most primary care. If that is closer to what you want, our 2027 guide to starting a DPC practice and the guide to converting a practice to direct primary care are the better starting points.

Do Concierge Doctors Still Have to Follow Medicare Rules?

Yes, and this is the part of the plan to get right first. Medicare.gov's concierge care page says doctors who offer concierge care must still follow all Medicare rules. Medicare does not cover the membership fee, and the patient pays all of it.

The key rules on that page are:

• Doctors who accept assignment cannot charge extra for Medicare-covered services. The membership fee cannot include charges for items or services Medicare usually covers, unless Medicare won't pay for them, in which case the doctor must give the patient an Advance Beneficiary Notice of Noncoverage (ABN).
• Doctors who don't accept assignment can charge more than the Medicare-approved amount for covered services, up to the 15% "limiting charge."
• All Medicare doctors can charge for items and services Medicare doesn't cover.

The warning behind those rules is older than most concierge practices. On March 31, 2004, the HHS Office of Inspector General issued an alert to physicians about added charges for covered services. It described a physician whose annual contract offered things like "coordination of care with other providers," "a comprehensive assessment and plan for optimum health," and "extra time." The OIG alleged that at least some of those were already covered by Medicare, so each contract was a request for extra payment for covered services and a violation of the assignment agreement. The physician settled and stopped offering the contracts.

The OIG alert's example contract carried an annual fee of $600.

The practical lesson is that the wording of your membership agreement matters as much as the fee. List the specific non-covered services and amenities the membership pays for, and keep anything Medicare already pays for (a covered visit, care coordination that is billable) out of the membership promise. This is where a healthcare attorney earns their fee, and where the networks' legal teams do much of the work for affiliated physicians.

Is a Concierge Practice Regulated Like Insurance?

It can be, depending on your state. A membership that promises future medical care in exchange for a prepaid fee can look like insurance to a regulator, and states handle that differently. Medicare.gov itself notes that "additional state laws and consumer protections may apply" and points patients to their state insurance department.

Washington is a useful example of how specific these laws get. Its direct health care practice law, RCW 48.150, sits inside the state's insurance title and sets conditions a "direct practice" must meet to stay outside insurance regulation, including disclosures to patients and rules about third-party payments under RCW 48.150.050. Washington requires the patient disclosure to say the practice will not bill a carrier for services covered under the direct agreement. A concierge practice that keeps billing insurance for covered visits needs to look closely at whether a law like this applies to it at all, and what does apply instead.

Because these laws are written mostly with DPC in mind, our guide to direct primary care laws by state is a good map of where your state stands, but a concierge model that bills insurance often needs its own legal review on top of that.

Should You Join an Affiliation Network or Go Independent?

Most physicians who convert to concierge medicine face this choice early. An affiliation network brings a brand, a legal team, marketing and a tested conversion process. Going independent keeps more of the fee and more of the control, and puts all of that work on you.

MDVIP's physician FAQ describes a no-cost practice evaluation, transition support covering operations, marketing, technology and legal, and help placing patients who don't join with other local physicians. It says its practices remain compatible with Medicare and commercial insurance and that affiliated physicians keep panels of around 600 members. The same FAQ gives its typical annual fee range.

MDVIP says its annual fee is typically $2,400 to $5,000.

How Much Do Concierge Practices Charge?

Fees vary more in concierge medicine than in DPC. KFF Health News reported in July 2024 that annual fees range from the low hundreds for Amazon's One Medical, to low four figures for networks such as MDVIP and SignatureMD, to five figures at top-branded practices like Massachusetts General Hospital.

In KFF Health News's figures, the range runs from $199 a year at One Medical to $10,000 or more at the top end. Its April 2024 report found hospital concierge programs charging $2,000 or more a year, sometimes above $4,000, with Baptist Health in South Florida at $2,500 a year.

When you set your own fee, work backward from the panel you want and the hours you want to work, then check that figure against what nearby concierge and DPC practices charge. Our post on how much to charge for a DPC membership and the DPC break-even panel size math apply to concierge pricing too, with one difference. A concierge practice that keeps billing insurance has claims revenue on top of membership, so its break-even panel can be smaller than a DPC practice's at the same fee.

What Are the Startup Costs of a Concierge Practice?

We could not find a reliable published figure for concierge startup costs, so we won't guess at one. What we can say is where the money goes. A conversion of an existing practice usually costs less than a new practice, because the lease, equipment and payer contracts are already in place. The costs that change are:

• legal review of the membership agreement, Medicare compliance and state law;
• patient communication (letters, mailings, events, a new website);
• membership billing software alongside your existing EHR and claims billing;
• the income gap while the panel shrinks and new members sign up;
• network fees or revenue share, if you affiliate.

The income gap is the cost most physicians underestimate. Plan your personal finances for the months between the patient letters and the point when the membership revenue settles.

How Do You Convert to Concierge Medicine? (Step-by-Step Timeline)

A typical conversion plan runs most of a year from the first decision to the first day as a membership practice. The timeline below is a planning shape, not a rule, and an affiliation network will run its own version.

Writing the patient letter

The transition letter is the moment most patients learn about the change, so it should be warm, clear and early. Explain why you are changing in your own words, what the membership includes, what the fee is, when it starts, and what happens if the patient decides not to join. Give a date by which they need to decide, and a way to ask questions that reaches a real person.

The most important paragraph is the one for patients who won't join. KFF Health News's July 2024 report describes patients left searching for a new doctor after a conversion, in markets where many primary care practices are not taking new patients. A good continuity plan (names of local practices accepting patients, a simple way to request records, and a promise to keep caring for them until the change date) protects those patients and protects your reputation in the community.

Can Patients Use an HSA for a Concierge Membership?

Generally not under the new rule, and it is worth being careful with patients about this. The One Big Beautiful Bill Act (Public Law 119-21) made qualifying direct primary care service arrangements compatible with HSAs starting January 1, 2026. To qualify, the arrangement has to provide only primary care, and a fixed periodic fee has to be the sole compensation for that care. IRS Notice 2026-5 says an arrangement does not qualify if members are billed separately for care that comes with the membership.

Separately, members can keep contributing to their HSA while enrolled only if the arrangement's fees stay within a monthly cap, which Rev. Proc. 2026-24 keeps for 2027 at 150 dollars a month for one person and 300 dollars a month for a membership covering more than one person.

A concierge practice that bills insurance or Medicare for visits tied to the membership generally does not fit that definition, and many concierge fees are also well above the contribution cap. That doesn't make concierge membership illegal or improper. It means patients should not assume their membership keeps them HSA eligible or can be paid from their HSA under this rule. Our DPC HSA rules for 2027 post covers the definition in detail, and anything specific should go to a tax advisor.

What Software Does a Concierge Practice Need?

A concierge practice runs two kinds of billing at once, and that is what makes its software different from a DPC clinic's. You need recurring membership billing for the annual or monthly fee, and you still need your EHR and claims billing for insurance and Medicare visits. Most practices add patient messaging and scheduling that can honor the access promise, such as same-day slots held for members.

Our guide to the best concierge medicine software for 2027 compares the tools by job, with prices checked on each vendor's site.

The friction in a concierge practice usually lives between those tools. A member texts after hours, the message needs to reach the doctor, a visit gets booked, the claim goes to insurance, and the membership record needs to show the member is current. When each step sits in a different system, small things slip. Tabflows is a dedicated tech team that connects the tools a clinic already uses (the EHR, billing and messaging) so that follow-ups, tasks and patient context end up in one place and the work between systems gets done.

Your 2027 Concierge Launch Checklist

If you are planning a concierge launch or conversion for 2027, these are the steps to work through, in roughly this order:

1. Decide between full concierge, hybrid concierge and DPC, using DPC vs concierge medicine as a guide.
2. Book a healthcare attorney to review Medicare assignment rules, the 2004 OIG alert, your payer contracts and your state's law.
3. Choose an affiliation network or the independent path.
4. Set your fee and write a membership agreement that names the non-covered services it pays for.
5. Choose and connect your software for membership billing, claims, messaging and scheduling.
6. Send patient letters about six months ahead, with a clear continuity plan for patients who don't join.
7. Tell patients plainly how the membership relates to their HSA and insurance.
8. Launch, then track renewals and how well you keep the access promise in the first year.

Concierge medicine asks a lot of a physician in the year of the change, but the core idea is simple and humane. A smaller panel gives you the time to know each patient well, and getting the rules and the letters right at the start is what lets that time go to patients instead of paperwork.