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Concierge medicine provides options ahead of Obamacare deadline

There are just over 2 months to go until the March 31 deadline to sign up for health insurance under Obamacare, and not everyone is sold on purchasing the kind of comprehensive and often pricey plans offered in the insurance exchanges set up under the law.

One alternative that may hold some appeal, especially for those under 30, is concierge medicine. With concierge medicine, you pay a regular retainer monthly or annually for the right to have a doctor manage your health care and perform basic procedures such as checkups and tests.

Paired with a high-deductible health insurance plan, it can meet a broad variety of health care needs without having to do the messy insurance dance for most of your medical care. Certain concierge practices, including AtlasMD, even offer house calls as a membership benefit.

Despite the name, concierge medicine isn’t always pricey

The name makes it sounds pricey — and you definitely can pay A LOT for concierge medicine — but it doesn’t have to be. According to research conducted by the Concierge Medicine Research Collective in 2013 and published in Concierge Medicine Today, approximately 70 percent of concierge medicine patients paid between $50 and $180 a month for basic medical care and doctor accessibility. Between 62 percent and 67 percent of patients paid less than $135 per month. A typical concierge medicine provider like the group SignatureMD, with providers all over the country, charges an annual retainer fee between $1,500 and $2,000.

Most concierge medicine providers are internal medicine specialists — the type of general physician you’d typically list as a primary care physician. In 2012, the Collective reported 60 percent of concierge physicians were internal medicine specialists with the second most common type of concierge medicine provider being family practices, which also treat children.

Concierge providers cover a long list of procedures under their monthly membership fees. Dr. Josh Umbehr of AtlasMD, a concierge-style medical office in Wichita, Kansas, says his practice covers “laceration repair/stitches, biopsies, joint injections, cryotherapy, medical laser treatments, spirometry, EKGs, audiometry, urinalysis, rapid strep testing, lesion removal, pap smears, minor surgical procedures and more.”

“Services typically include physical exams, blood work, unlimited office visits and other services,” says Michael Tetreault, editor of Concierge Medicine Today. “Fees typically cover basic services that include preventive care, routine physicals, longer appointments, next-day appointments, 24-hour-a-day phone access and e-mail, house calls, coordination of care when you travel and a CD with your medical records.”

The exact benefits of membership vary based on practice and membership does not cover the cost of prescription medication, nor all possible services required, though concierge doctors are often able to negotiate lower prices on services not covered by the practice.

According to data gathered by Tetreault and others, including Bargaineering, many tests and screenings can be substantially cheaper at concierge clinics than at hospital labs.

Tetreault cites a concierge physician in Atlanta who has negotiated with a local facility to get CAT scans for his patients at only $150. According to the Healthcare Bluebook, CAT scans at other facilities hover between $500 and $700 [3], with some types reaching into the thousands. A colonoscopy costs an average of $2,000 at a lab, hospital or screening facility, while the average concierge price is $400. A mammogram goes from $350 down to $80. The prices of brain MRIs and X-Rays, respectively, are nearly halved.

“(I have) noticed that any patient that comes in as a ‘cash pay’ will always pay less than what a hospital or imaging center is billing the insurance for the same test,” says Dr. Tiffany Sizemore-Ruiz, a concierge doctor in the Miami-Fort Lauderdale area.

Concierge medicine is not exclusive to general care physicians; the practice is continually growing and many surgeons, for instance, are also offering up their services for out-of-pocket payments. One New York City-based concierge orthopedic surgery practice lists the costs of procedures upfront on its website.

How concierge medicine fits in with Obamacare

Patients who choose concierge medicine often opt to also purchase a catastrophic insurance policy in the event of a major medical emergency.

Under Obamacare, specific rules about what such insurance plans must cover have gone into effect, increasing their cost to around $130 to $140 per month for those under 30. Unlike a conventional health insurance policy, catastrophic plans are intended for “worst case scenarios” and everyone pays the same monthly premium [4], regardless of income.

Catastrophic policies typically have low monthly premiums but higher deductibles than regular insurance plans — up to $6,350 for individuals or $12,700 for multi-person plans.  On the other hand, while premiums for a catastrophic policy vary based on state, insurance type and health factors, they’re usually considerably lower than for more comprehensive policies.

In the event of a catastrophe, you’ll only pay the big bucks until you reach the deductible amount, at which point the insurance plan will cover you. Under Obamacare, catastrophic policies are reserved for those under 30, or who qualify for one of many exemptions [5].

Those who decide to opt out of buying health insurance through Obamacare and participate solely in concierge medicine must also take into consideration the financial penalty not having insurance will incur. This fee will start at $95 per adult in 2014, or one percent of their income (whichever is greater), with the fee rising each year.

Uninsured penalties under the ACA [6] | Infographics [7]

Solutions are in the works, though, that could better integrate concierge medicine into the Obamacare framework.

“There is a real chance that concierge medicine … could flourish under the Affordable Care Act,” says Kenneth E. Thorpe, a professor of health policy and management at Emory’s Rollins School of Public Health.

Insurance companies and medical providers are currently in talks over other “wrap-around insurance plans” that could be added to a concierge membership, Thorpe says.

So what’s been the impact of the Obamacare rollout on concierge medicine? According to a 2012 survey conducted by the Concierge Medicine Today Research Council, 90 percent of concierge physicians reported they were doing better financially than the previous year.

“My practice has grown steadily since the ACA was passed,” Knope says. “This is true of all the concierge doctors that I know.”

“Patients tell me that they are very concerned about finding a concierge doctor before all of the concierge practices are full,” Knope says. “Legitimate fear of the ACA is driving a great deal of demand for concierge services.”

Getting started

Dr. Steven D. Knope, a concierge medicine practitioner in Tucson, says the best way for a person to go about finding a good concierge practitioner is looking online. Knope suggests beginning with an Internet search, as almost all concierge doctors have their own websites. He advises then checking the doctor’s credentials.

“If he or she appears to be well-trained and qualified, call the office to set up an interview,” Knope says. “You will want to see if this is a good match before you write a check.  An interview with the doctor is an opportunity to see how you feel interacting with this person.”

What do you think? Do you have any experience with concierge medicine?

(Photo [8] by Eva Blue / CC BY [9])