Side by side
| Direct primary care | Concierge medicine | |
|---|---|---|
| Insurance billing | Usually none for covered services (hybrid practices may bill) | Often bills insurance or Medicare for covered care |
| Fee | Generally $50 to $100 a month (AAFP) | Usually higher; set by your contract |
| What the fee buys | All or most primary care at the practice | Access and amenities on top of covered care |
| Who it serves | AAFP: often crosses all income levels | AAFP: often higher-income patients |
How billing differs
The AAFP says DPC practices typically don't accept insurance or take part in government programs, relying on membership fees. The AMA notes that hybrid DPC practices do bill insurance on top of the monthly fee.
Concierge practices charge higher membership fees and may keep billing insurance for covered services. So with concierge care you may pay the fee plus your usual copays, coinsurance and deductible.
Concierge care and Medicare
Medicare.gov says Medicare doesn't cover concierge membership fees. You pay them yourself. Medicare's rules still apply to the care inside the practice:
- A doctor who accepts assignment can't charge you extra for Medicare-covered services.
- The membership fee can't be a charge for Medicare-covered items or services.
- A doctor who doesn't accept assignment can charge up to 15% over the Medicare-approved amount.
- Any Medicare doctor can charge you for services Medicare doesn't cover.
Which one fits you
- DPC may fit if you want a lower, predictable fee for primary care and you have a plan for big bills.
- Concierge may fit if you want to keep using your insurance for covered care and will pay more for extra access.
- HSA owners: since 2026, a qualifying DPC arrangement up to $150 a month for one person doesn't block HSA contributions. An arrangement that bills members separately doesn't qualify (IRS Notice 2026-5), so a concierge practice that bills insurance on top of its fee is unlikely to qualify. See HSA and direct primary care.
Before you sign, ask what the fee covers, what's billed separately, whether the practice takes your insurance or Medicare assignment, and how to cancel.
Where Gabriel Core and Plus fit
Gabriel Core is $49 per adult a month, kids under 18 included, cancel anytime. It includes unlimited virtual urgent care and unlimited virtual primary care, plus member prices close to cost on lab tests, supplements, prescriptions and bioregulators. Gabriel Plus, $89, adds two in-person urgent care visits a year, a yearly lab kit and a root-cause visit. Both are memberships, not health insurance.
Common questions
What is the difference between concierge medicine and direct primary care?
DPC usually charges one lower fee and doesn't bill insurance for covered services. Concierge practices charge a higher fee and often still bill your insurance for covered care.
Is concierge medicine more expensive than direct primary care?
Usually. The AAFP says concierge practices charge higher membership fees, while DPC fees generally range from $50 to $100 a month.
Does Medicare cover concierge medicine?
Medicare doesn't cover the membership fee. It still covers Medicare-covered services, and a doctor who accepts assignment can't charge you extra for them.
Can I use my HSA for concierge medicine?
The rules are stricter than for DPC. An arrangement that bills members separately for services isn't a qualifying DPC arrangement under IRS Notice 2026-5, so check with a tax advisor.
Do I still need insurance with concierge medicine or DPC?
Yes, for most people. Neither membership pays for emergencies, hospital stays or specialists.
Sources
- Direct Primary Care Model for Family Physicians American Academy of Family Physicians
- Pondering direct primary care? 10 potential benefits and drawbacks American Medical Association
- Concierge care Medicare.gov
- Notice 2026-5: direct primary care service arrangements and HSAs Internal Revenue Service
This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.