Concierge Medicine Membership Agreements

Quick answer: A concierge medicine membership agreement should explain, in plain language, what the membership fee buys and what it does not, how that fee relates to services billed to insurance or Medicare, what access patients can actually expect, which outside services are included or billed separately, and how the membership renews, ends and is refunded. The agreement should match how the practice really runs, and it should match the website, enrollment form and billing system word for word.

A concierge membership changes what patients expect from their physician. The membership agreement is where those expectations are set. In my work with concierge and direct primary care practices, the strongest agreements are built from a clear plan of how the membership will run day to day, not from a template. This article explains what I recommend physicians settle before opening enrollment or revising an existing membership.

What should the membership fee buy?

List each benefit you intend to offer. For each one, note what the patient receives, how often and who provides it. Common examples include longer appointments, same-day or next-day scheduling, direct messaging or phone access and an annual wellness plan. Your list should describe your own model, not a competitor's brochure.

Then separate those membership benefits from the medical care patients may also receive. Many concierge practices continue to bill insurance or Medicare for covered visits and services. Patients need to understand which charges come from the membership fee and which are billed separately.

Avoid broad promises such as "unlimited access" or "everything included" unless your schedule, staffing and billing actually support them.

How does Medicare treat concierge membership fees?

Medicare's own guidance for patients states that Medicare does not cover membership fees for concierge care. It also explains that doctors who accept assignment cannot charge extra for Medicare-covered services, and that a membership fee cannot include additional charges for items or services Medicare usually covers. Doctors who do not accept assignment may charge more than the Medicare-approved amount for covered services, subject to a 15% limiting charge. All Medicare doctors may charge for items and services Medicare does not cover. Medicare.gov: Concierge care

That guidance raises separate questions that one "cash membership" label cannot answer:

What exactly does the membership fee pay for?
Is each of those items or services covered by Medicare?
Does the physician accept assignment for covered services?
What is the physician's Medicare enrollment status?

Serving Medicare beneficiaries does not automatically require a physician to opt out of Medicare, and opting out is a separate decision with its own requirements. Bring your Medicare participation status, intended patient mix and proposed benefit list to counsel before you finalize the fee structure.

Use a benefit worksheet before drafting

I recommend a simple worksheet before anyone drafts contract language. For each proposed benefit, record:

A plain description of the benefit;
What the membership fee pays for, and what it does not;
Whether anything is billed separately to the patient, an insurer or Medicare;
Which payer contracts, Medicare rules or state rules need review; and
Who in the practice will confirm how the benefit is classified.

Do not label a benefit "non-covered" until those facts are checked. The same service can be treated differently depending on how it is delivered and billed. Medicare also changes, so a service that is not covered today may be covered in the future. If the practice bills private insurers, review those payer contracts as well for any terms on charging their members.

Describe access and response times honestly

Access is often the reason patients join, so the promise needs to be specific. State when patients can reach the practice, how they should contact it and what response time they can expect during and after business hours. Explain who covers when you are traveling, ill or on vacation, and what patients should do in an emergency. Estimate how many patients you can keep on your panel while keeping to those promised response times.

If you commit to answering messages within a set time, make sure your staffing and phone systems can keep that promise every day. A promise the practice cannot keep becomes a patient-relations problem and possibly a contract dispute.

Name the services other people provide

Concierge memberships often involve outside clinicians, labs, imaging centers or wellness vendors. The agreement should say whether those services are included, discounted or billed separately, and who bills the patient. If a partner changes or leaves, patients should not be surprised by a new charge. Where outside vendors will receive patient information, review those relationships under HIPAA and any other confidentiality duties that apply to the practice.

Plan how membership ends

Every agreement should explain renewal, cancellation and refunds in plain language. Settle:

How and when a patient can cancel, and how much notice is required;
Whether a prepaid fee is partly refunded, and how the amount is calculated;
How the practice can end the relationship, with appropriate notice; and
How patients obtain their records and continue their care after membership ends.

State law may affect these terms. Georgia and Ohio both have statutes written specifically for direct primary care agreements, with their own notice, refund and disclosure terms. O.C.G.A. § 33-7-2.1; R.C. § 3901.95. A concierge practice that also bills insurance should not assume it qualifies for, or must follow, those DPC provisions. Review the rules that apply to your actual arrangement in South Carolina, Georgia or Ohio.

Converting an existing practice to concierge

If you are moving an established practice to a membership model, plan for the patients who do not join as carefully as for those who do. Decide how and when patients will be told about the change, how long they will have to decide, and how you will help those who do not enroll transfer their care and records. Give patients reasonable notice and avoid leaving anyone in active treatment without a path to continued care. You may also consider continuing to treat them outside of the concierge model, which requires careful planning.

Make the documents match

Before enrollment opens, read the agreement side by side with your website pricing, enrollment form, fee schedule and billing setup. Check that the benefits, prices, renewal dates and cancellation steps are identical everywhere. A patient who reads one promise on the website and a different one in the agreement will reasonably ask which one applies.

Checklist: what to bring to your agreement review

[ ] Benefit worksheet with each benefit classified
[ ] Proposed membership fees, payment schedule and renewal dates
[ ] Medicare participation and assignment status, and intended patient mix
[ ] Private payer contracts the practice participates in
[ ] Access promises: hours, channels, response times and coverage
[ ] List of outside partners, what they provide and who bills the patient
[ ] Cancellation, refund and termination terms
[ ] Transition plan for patients who do not join (for converting practices)
[ ] Current website pricing page and enrollment form
[ ] Any draft agreement, with settled and open terms marked

This checklist prepares a conversation. It does not certify compliance or replace a review of your specific arrangement.

Common questions

Does Medicare pay concierge membership fees?

No. Medicare.gov states that Medicare does not cover membership fees for concierge care. Whether a particular service is covered, and whether the physician accepts assignment, are separate questions.

Can a concierge membership fee include services Medicare already covers?

Medicare's guidance states that a membership fee cannot include additional charges for items or services Medicare usually covers when the doctor accepts assignment. That is why the benefit worksheet matters: each benefit needs to be classified before the fee is set.

Can patients use HSA funds for a concierge membership fee?

Do not assume so. The federal HSA rules for 2026 address direct primary care arrangements that meet specific conditions, including monthly fee limits. A concierge membership that bills insurance or exceeds those limits should not be described as HSA-compatible without review. My article on direct primary care HSA rules explains those conditions.

Is there a standard concierge membership agreement template?

A template can be a starting point, but the agreement should describe your own services, fees, access promises and cancellation process, and reflect the rules that apply in your state and to your payer relationships.

Is a concierge practice the same as a direct primary care practice?

Not necessarily. Many concierge practices charge a membership fee and also bill insurance; many DPC practices do not bill insurance for the services covered by the periodic fee. The difference affects which state DPC provisions, Medicare rules and HSA rules may apply. However, simply referring to your practice as DPC or concierge does not make it so.

Sources

Discuss your concierge membership agreement

I work with physicians starting and running concierge, direct primary care and direct specialty care practices, including membership agreements, practice setup and the policies behind them. If you are launching a concierge membership, converting an existing practice or revising your agreements, explore my healthcare legal services or request a consultation. Keep the first inquiry general and leave out patient information and confidential records. Related reading: Does HIPAA Apply to Your DPC or Cash-Pay Practice? and Starting a Direct Primary Care Practice in South Carolina.

Serving South Carolina, Georgia, and Ohio.

General educational information, not legal advice. Current law and your particular arrangement determine the appropriate approach. Reading this article or contacting the firm does not create an attorney/client relationship.