How this works
Not alternatives. You want both.
They cover different things. You will almost certainly want both.
Concierge medicine works alongside your insurance, not instead of it. The membership fee is paid directly to the practice and covers your relationship with your physician. Your insurance continues to cover care delivered elsewhere: specialists, imaging, hospital stays and prescriptions. Insurance does not reimburse the membership fee.
Where we stand
The position, stated plainly.
Insurance and Medicare do not cover the membership fee. However, many members find that their HSA or FSA funds can be used to pay for concierge services; please consult your tax advisor to confirm.
Yes, you still need insurance. We do not participate in any insurance networks, including HMOs, Tricare Prime, or Medicaid. Your membership covers your care with Dr. Sisodia, and it does not pay for care delivered anywhere else. You will need insurance for emergency care, routine bloodwork and laboratory tests, imaging, hospital stays, surgery, and specialist visits and procedures.
The split
What each one pays for.
Membership and insurance cover different things. One does not replace the other.
| Your membership | Your insurance | |
|---|---|---|
| Primary care visits | Covered. Extended and unhurried, same-day or next-day. | Not used for these. |
| Direct access to your physician | Covered. Phone, text or video, directly. | Not a benefit insurance provides. |
| Specialists | Coordination is covered. The specialist is not. | Covers the specialist visit under your plan. |
| Imaging and labs | Ordering and interpretation are covered. | Covers the imaging or lab itself under your plan. |
| Hospital care | Coordination and continuity are covered. | Covers the hospital stay under your plan. |
| Prescriptions | Prescribing and review are covered. | Covers the medication under your plan. |
Side by side
Against a traditional practice.
The structural differences, not the marketing ones.
| My Choice Primary Care | Traditional insurance-based practice | |
|---|---|---|
| Panel size | Capped at 150 patients. | Commonly in the thousands. |
| Appointment length | Extended, and not cut short. | Short by necessity, set by volume. |
| Getting seen | Same or next day. | Often weeks out. |
| Reaching your physician | Phone, text or video, directly. | Through the office, with a delay. |
| Coordination | Managed by the practice, including hospital and specialist connections. | Frequently left to the patient. |
| Billing | One membership fee, set by a stated formula, with no surprise billing. | Copays, deductibles and after-the-fact billing. |
| Continuity | One physician who knows your history. | Often starting again each visit. |
The other side
The honest caveat.
Every difference above is real, and none of it makes this the right choice for everyone.
Everything above is a real structural difference, and none of it makes concierge care the right answer for everyone. You are adding a cost that insurance will not reimburse. If you rarely see a physician and have no ongoing conditions, that cost may not return its value. We would rather you weigh that properly than join and regret it.
Common questions
Insurance and Medicare.
- Does insurance or Medicare cover the membership fee?
- Insurance and Medicare do not cover the membership fee. However, many members find that their HSA or FSA funds can be used to pay for concierge services; please consult your tax advisor to confirm.
- Do I still need health insurance?
- Yes, you still need insurance. We do not participate in any insurance networks, including HMOs, Tricare Prime, or Medicaid. Your membership covers your care with Dr. Sisodia, and it does not pay for care delivered anywhere else. You will need insurance for emergency care, routine bloodwork and laboratory tests, imaging, hospital stays, surgery, and specialist visits and procedures.
Next step
Still weighing the trade?
Half an hour with the physician answers more than any page.