Do You Still Need Health Insurance with Concierge Medicine?

The short answer: yes. Concierge medicine is not health insurance and does not replace it. The membership fee buys you a primary care relationship, not a hospital stay.

The longer answer is worth understanding before you sign up.

What concierge membership at Diamond Cove covers

• All in-office primary care visits with the doctor
• Long, unhurried appointments
• Same-day or next-day visits when medically appropriate
• Direct phone access during business hours
• Comprehensive annual exam
• Coordination of outside care (specialists, imaging, hospital admissions, prescriptions)
• Hospital advocacy and visits when patients are admitted, where the doctor holds privileges

What concierge membership doesn't cover

• Specialists (cardiology, dermatology, orthopedics, gynecology, etc.)
• Hospitalization
• Imaging — MRI, CT, X-ray, ultrasound
• Lab work performed at outside labs
• Surgery
• Prescriptions filled at outside pharmacies
• Emergency room visits
• Mental health services beyond what primary care normally addresses
• Dental and vision care

That list is most of what makes healthcare expensive. You still need insurance for it.

What insurance to keep, in plain terms

The right insurance plan depends on your specific situation, but the broad pattern for concierge patients is:

Medicare patients typically keep their Medicare (Parts A and B at minimum) and often have a supplemental plan or Medicare Advantage plan to cover what original Medicare doesn't.

Working-age patients typically keep their employer-based insurance, an ACA marketplace plan, or COBRA — whatever they would have without concierge medicine. The concierge membership is added on top.

Self-employed patients often choose higher-deductible plans paired with HSAs, since they're paying the membership fee out of pocket and primary care is no longer a major source of insurance claims.

Your insurance broker can help you think through whether your current plan is the best fit given the membership.

Does the membership fee qualify as a medical expense?

This is a tax question, and we are not tax professionals. Some patients in some circumstances treat concierge membership as a deductible medical expense; others don't. The IRS has historically taken a narrow view of what qualifies. Consult your accountant about your specific situation.

Will my insurance pay any of the membership fee?

Generally, no. Health insurance plans don't typically reimburse concierge membership fees. Some flexible spending accounts (FSAs) or health savings accounts (HSAs) may allow you to use pre-tax dollars for portions of the fee, depending on the specific plan rules and what the membership covers — this varies and patients should verify with their FSA/HSA administrator.

What if I don't have insurance?

You can still join a concierge practice. The membership covers your primary care. But you would be unprotected for everything outside primary care — hospitalization, specialists, imaging, surgery — which is where most catastrophic medical bills come from. We strongly encourage all patients, members or not, to maintain health insurance for those situations.

The bottom line

This model and health insurance are complementary, not redundant. The membership replaces what you'd otherwise pay for primary care visits. Insurance still covers everything else. Most patients keep both, and the combination tends to produce a smoother, more thorough, and more coordinated experience than either alone.