Concierge medicine marketing: membership fees, Medicare rules and honest offers

Concierge and membership practices sell something different from a usual practice: access. Longer visits, same-day appointments, direct messaging with the physician, a smaller patient panel. Patients pay a recurring fee for that, sometimes on top of insurance, sometimes instead of it.

Marketing a membership raises questions most practices never face. What exactly does the fee buy? How does it fit with Medicare? How is it billed, renewed and cancelled? This guide covers the federal rules that shape the answers and how to put them into plain, honest marketing. It does not cover state insurance or direct primary care laws, which vary by state and need local advice. Practices that sell executive physicals should read executive physical marketing, which covers screening tests in people without symptoms.

The Medicare question comes first

If any of your patients have Medicare, the most important marketing decision is what the membership fee is said to cover, because that description has legal consequences.

On March 31, 2004, OIG issued an alert reminding Medicare participating physicians that they may charge beneficiaries for items and services Medicare does not cover, and may collect deductibles and coinsurance, but that requesting any other payment for covered services can expose them to substantial penalties and exclusion. The alert described a case in which OIG alleged that a physician’s annual 600 dollar contract fee covered services such as coordination of care with other providers, a comprehensive assessment and plan, and extra time spent on patient care, at least some of which OIG alleged were already covered by Medicare. The physician agreed to pay a settlement and stop offering the contracts.

The alert also notes that non-participating providers can face penalties and exclusion for overcharging beneficiaries for covered services.

For marketing, the lesson is direct. A membership page that lists Medicare-covered services, such as care coordination or a thorough assessment, as the things the fee pays for can describe the arrangement in exactly the way OIG warned about. Your attorney should decide what the fee covers, and your marketing should describe it the same way, no more and no less.

Opting out of Medicare and private contracts

Some concierge and direct pay physicians opt out of Medicare entirely and contract privately with Medicare patients. 42 CFR 405.410 sets out how opt-out works: the physician files an affidavit with each Medicare Administrative Contractor they would otherwise bill, and opt-out runs in 2-year periods. 42 CFR 405.415 lists what each private contract with a Medicare beneficiary must say. Among other things, the contract must:

• Be in writing, in print large enough for the beneficiary to read, and signed by both sides.
• State that the beneficiary accepts full responsibility for payment and understands that Medicare limits do not apply to what the physician may charge.
• State that the beneficiary agrees not to submit a claim to Medicare and understands Medicare will not pay for the services.
• State that the beneficiary has the right to get Medicare-covered services from physicians who have not opted out.
• State that Medigap plans do not, and other supplemental plans may elect not to, pay for services Medicare does not pay for.
• State the effective and expiration dates of the current 2-year opt-out period.
• Not be entered into while the beneficiary needs emergency or urgent care.

Marketing to Medicare patients should match those terms. Do not imply that Medicare will reimburse the visits, that a Medigap plan will pay, or that patients have no other options. If you have opted out, say so plainly on the site, and explain what that means for the patient in the same words your contract uses.

Describe the membership plainly

Most complaints about memberships come from a gap between what the page implied and what the agreement said. A clear membership page answers, in this order:

1. What the fee is. The amount, the billing period, and whether it is charged monthly or annually.
2. What it includes. The access features you actually provide, worded the way your agreement words them.
3. What it does not include. Labs, imaging, specialist visits, procedures, medications and anything billed separately, and whether insurance is billed for visits.
4. Who it is for, and who it is not for. Including what Medicare patients need to know.
5. How renewal and cancellation work. Notice period, refunds for unused time, and how to cancel.

Avoid promises you cannot keep for every member at every moment, such as always same-day or 24/7 access, unless you can deliver them. If availability depends on circumstances, say so.

If your practice runs on a fixed monthly fee with no insurance billing for included care, the 2026 federal change on health savings accounts and how to word it is covered in our guide to direct primary care marketing.

Online sign-up and automatic renewal

If patients can join and pay online and the membership renews automatically, the federal Restore Online Shoppers’ Confidence Act applies to that transaction. Under 15 U.S.C. 8403, a business may not charge a consumer through a negative option feature in an internet transaction unless it:

1. Discloses material terms first. Clearly and conspicuously discloses all material terms of the transaction before obtaining the consumer’s billing information.
2. Gets express consent. Obtains the consumer’s express informed consent before charging their card or account.
3. Makes stopping easy. Provides simple mechanisms for the consumer to stop recurring charges.

In practice: put the price, billing frequency, renewal terms and cancellation method next to the payment button, use an unchecked box or similar step for consent, and let members cancel online as easily as they joined. State automatic renewal laws can add more, so check your state’s statute.

Guarantees and trial offers

Some practices offer a satisfaction guarantee or a trial month. Under 16 CFR 239.3, terms such as satisfaction guarantee, money back guarantee or free trial offer should be used only if the full purchase price is refunded at the purchaser’s request, and any material limitations or conditions should be clearly disclosed. If your refund is prorated or only applies within a set window, say that next to the offer.

What tends to work, inside the rules

1. A physician-led about page. Who the physician is, why they practice this way, and how many patients they plan to care for.
2. A plain membership page. The five answers above, in the same terms as the agreement.
3. A short discovery call. Offered as a way to ask questions, not a sales pitch, with clear notes on what will and will not be discussed.
4. Consistent answers everywhere. The website, the phone and any assistant give the same description of the fee; our integrative medicine marketing page explains how we keep membership questions consistent.
5. Accurate local listings. The real practice name and hours on your Google Business Profile, as covered on our healthcare SEO page.

If your practice also sees self-pay patients for individual services, the good faith estimate rule may apply; see our guide to good faith estimates for self-pay patients. For marketing claims more broadly, start with healthcare marketing rules.

How to describe opted-out, nonparticipating and never-enrolled status on your site, in ads and at booking is covered in our guide to Medicare opt-out practice advertising.

Sources

• HHS OIG (March 31, 2004): OIG Alerts Physicians About Added Charges for Covered Services
• 42 CFR 405.410: Conditions for properly opting-out of Medicare
• 42 CFR 405.415: Requirements of the private contract
• 15 U.S.C. 8403: Negative option marketing on the Internet (ROSCA)
• 16 CFR 239.3: Satisfaction guarantees and similar representations in advertising

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