How to start a concierge medicine practice

To start a concierge medicine practice, decide what the membership buys and whether you will continue billing insurance. Settle your Medicare status before pricing the agreement, then build the schedule, coverage, patient communication, and business setup around that choice. If you are converting an existing practice, plan both paths: care for patients who join and a workable transition for those who decline.

Concierge care uses a membership or retainer fee and may retain insurance billing. This guide is for licensed clinicians; Medicare and ethics sources were checked October 12, 2026. Have counsel review the proposed agreement and state requirements.

How do you start a concierge medicine practice?

Start with a written description of access and services. Then identify which charges belong to membership and which may be billed separately. Do the payer and legal review before announcing a fee. The resulting agreement should match the appointments, staffing, and backup coverage you can actually deliver.

1. Review your employment agreement or, if you own the practice, your existing patient and payer obligations.
2. Choose the membership services and proposed access terms.
3. Decide your Medicare participation or opt-out path with counsel.
4. Review membership terms against Medicare rules, commercial contracts, and state law.
5. Build a staffing, capacity, and absence-coverage plan.
6. Complete the entity, identifiers, malpractice, records, and billing work in the private-practice guide.
7. Prepare patient communication and continuity plans before announcing the change.

If you intend the periodic fee to replace routine insurance billing for primary care, compare the DPC model before drafting the agreement.

What may a concierge membership fee cover for Medicare patients?

Medicare does not pay concierge membership fees. Clinicians who accept assignment cannot add charges for Medicare-covered services through membership. Medicare.gov describes a notice process when Medicare is expected not to pay for an ordinarily covered item. Have the billing and legal review distinguish that situation from services Medicare never covers. Medicare.gov's concierge-care rules are the starting point.

Medicare path	Agreement review needed
Accept assignment	Separate membership charges from covered-service payment; review any Advance Beneficiary Notice requirement for expected noncoverage
Nonparticipating	Review assignment and applicable charge limits; nonparticipation is not opt-out
Opt out	Complete the required affidavit and private contracts, with the correct effective date

An Advance Beneficiary Notice of Noncoverage (ABN) explains expected Medicare nonpayment in the situations where it applies. It is not a general waiver that makes any membership charge permissible. Obtain a service-by-service review before using one.

What does opting out of Medicare involve?

Opt-out requires two different documents: the clinician's affidavit and a private contract with each Medicare beneficiary receiving care under that arrangement. The regulations govern their content, timing, and continuing obligations. Use the checklist below to prepare the review; it is not a substitute form or a complete statement of every requirement.

Document or decision	What to resolve	Regulation
Affidavit	Signed clinician statements and filing with each relevant Medicare Administrative Contractor	42 CFR 405.420
Private contract	Required disclosures, signatures, patient copy, and record retention; do not enter it during emergency or urgent care	42 CFR 405.415
Effective date	Which start-date rule applies to your status	42 CFR 405.410
Ending opt-out	Renewal cancellation versus the separate early-termination process	42 CFR 405.445

For a participating physician, section 405.410 uses a calendar-quarter start with the affidavit submitted at least 30 days before that quarter. For a nonparticipating physician or practitioner, the initial-period rule depends on signing and timely filing, including the 10-day deadline after the first private contract. Have the contractor confirm the date before scheduling private-contract care.

To prevent the next two-year renewal, section 405.445 requires written notice to each relevant contractor no later than 30 days before the current period ends. Early termination has different conditions. Calendar the applicable dates and keep the supporting records with your enrollment documents.

What should the membership agreement explain?

Write the agreement around questions patients ask: what they receive, how they reach the practice, what costs extra, and what happens when the clinician is unavailable. Test every access promise against a normal week and a week with an absence. An agreement is easier to deliver when its terms are concrete.

Patient question	Operational answer to define
What does my fee buy?	The included services or amenities and their limits
Do visits still go to insurance?	Which care is billed separately, with applicable patient costs
When can I reach someone?	Channels, response hours, urgent-care route, and backup clinician
What if I need outside care?	Referral coordination and charges outside the agreement
Can I leave?	Cancellation, refund, renewal, records, and continuity terms

The AMA's retainer-practice ethics guidance calls for clear, voluntary agreements, transparent billing, and the same standard of medical care regardless of special amenities. Explain the service without implying that paying the retainer buys better clinical judgment.

How do you convert an existing patient panel?

Create a communication and continuity plan before sending a membership announcement. If you are employed, resolve who has the right to contact patients and use records first. If you own the practice, prepare an understandable choice for each patient, including what happens if they do not join.

1. Have counsel review the communication, timing, and transfer process.
2. Explain the new fee, included services, and separate billing in plain language.
3. Provide a route for questions and a voluntary decision.
4. Track patients who decline and help arrange ongoing care.
5. Follow through on records transfer, pending results, referrals, and medication questions.

AMA guidance says to facilitate transfer for patients who decline. If a local transfer is not feasible, it calls for continuing care under the existing insurance arrangement until appropriate ongoing care can be arranged. Treat that as a continuity responsibility, not just a mailing task.

How do you set the fee and panel size?

Calculate the staff and clinician time required to deliver the agreement. Include records, messages, coordination, absences, and administrative work alongside appointments. Compare the resulting capacity with a budget using actual quotes. The startup-cost guide helps separate setup expenses from monthly commitments.

Test a slower membership start and higher-than-expected use. Ask whether the practice can still meet its access terms without relying on every member rarely needing care. Revisit the model if the panel needed to fund it exceeds the capacity to serve it.

Where can Vye Health help?

Vye Health helps providers launch, run, and grow private practices. Vye manages licensing, credentialing, malpractice insurance, and your website, and payer contracts if you want them.

Bring the draft agreement, Medicare questions, and patient-transition plan. Apply to Vye Health.