Concierge Medicine for Employers: How a 50-Employee Contract Works

Covering 50 employees at $100 per employee per month costs $60,000 per year. That is a real published employer rate from Elizabeth Story MD, a physician-led membership practice in Fort Worth, Texas. Its employer plan includes unlimited office and virtual visits, same-day or next-day access, and no copays.[1]

That number gives a 50-person company a useful starting point. The final cost depends on how many employees enroll, whether the employer includes dependents, and how much of the membership the company pays. Also worth noting, some doctors will give discounts for businesses.

The contract also needs to fit beside health insurance and comply with employee-benefit rules. A company near 50 full-time-equivalent employees has an additional reason to pay attention: 50 is the federal threshold for becoming an applicable large employer under the Affordable Care Act.[2]

This guide explains the contract models, cost ranges, legal questions, and purchasing steps.

What Employers Are Actually Buying

People often use concierge medicine as the broad name for membership-based primary care. Employer contracts usually fall into two related categories:

• Direct primary care (DPC) charges a fixed membership fee and does not bill insurance for primary care. NextMD directory data puts DPC memberships at $50 to $200 per month, or $600 to $2,400 per year. DPC panels run up to 800 patients per doctor.

• Concierge medicine charges a membership fee for increased access and usually continues billing insurance for covered medical services. Annual fees run from $3,000 to over $40,000. Concierge panels generally stay under 300 patients per doctor.

DPC usually fits whole-workforce coverage because its price is lower. Concierge medicine can fit an executive group or a smaller set of employees who need more physician access and care coordination.

Neither membership pays for a hospital admission, surgery, or the full cost of specialty care. Employees still need major medical coverage for those expenses. Our DPC versus traditional primary care cost comparison explains how the membership and insurance roles differ.

Three Contract Models for a 50-Employee Company

The right structure depends on where employees live and who pays the fee.

1. A direct contract with one local practice

The employer signs one agreement with a nearby physician-led practice. The company pays a monthly fee for each enrolled employee, and employees receive the practice's stated service bundle.

This model fits a company with most employees near one office. It keeps contracting simple and gives the workforce a local doctor. Capacity matters. A practice must have enough open panel space to enroll the group without reducing access for current members.

Published practice pricing shows how direct contracts can work:

• Elizabeth Story MD in Fort Worth: $100 per employee per month, including unlimited office and virtual visits.[1]

• Pulse Direct Care in Gilmer, Texas: 10% off for groups of 10 or fewer employees, 15% off for 11 to 49, and 20% off for 50 or more.[3]

Employers comparing local options can start with concierge and DPC practices in Texas, then ask each practice for its group terms.

Employer contracting is already common among surveyed DPC physicians. The American Academy of Family Physicians received 374 responses to its 2024 DPC study, including 177 physicians then working in DPC. Among those DPC respondents, 63% participated in signed or formal employer contracts. Seventy-one percent offered employers the same service bundle, while 28% customized the contract.[4]

2. A network contract for a distributed workforce

A company with employees in several cities may need a DPC network. The network signs participating practices, gives the employer one contract, and routes each employee to a local doctor.

The structure solves a geographic problem, but the employer should verify local coverage before signing. A national network can still have thin supply near a specific office or employee cluster.

Hint Health reported that its 2025 employer dataset included more than 7,200 employer sponsors, 2,400 DPC clinicians, and 1.2 million members. Thirty-five percent of practices working with employers received at least some memberships through DPC networks.[5] Those figures describe Hint's platform, not the entire national DPC market.

3. A negotiated group rate with employee contributions

The employer negotiates a group rate, then pays all or part of the monthly membership. Employees cover the balance through the benefit structure selected by the company and its advisers.

This structure lets an employer cap its contribution. It also makes voluntary enrollment possible when the company does not want to fund every membership in full. Participation may be lower when employees pay more of the fee, so the contract should state any minimum enrollment requirement.

Tax treatment and payroll administration depend on how the benefit is structured. A benefits broker, tax adviser, or Employee Retirement Income Security Act counsel should review the arrangement before launch.

What a 50-Employee Contract Can Cost

The following examples use the published $100 monthly rate from Elizabeth Story MD. They are planning scenarios, not quotes for another practice.[1]

Across NextMD's canonical pricing ranges, covering all 50 employees through DPC produces a wider planning range of $30,000 to $120,000 per year. Fifty entry-level concierge memberships at $2,500 to $5,000 each would cost $125,000 to $250,000 per year. Five premium concierge memberships for senior leaders at $5,000 to $12,000 each would cost $25,000 to $60,000 per year.

The quote should answer five pricing questions:

1. Does the employer pay for every eligible employee or only enrolled employees?

2. Are spouses and children included, optional, or priced separately?

3. Is there a one-time enrollment fee?

4. Which labs, vaccines, procedures, and medications carry an additional charge?

5. Can the price change at renewal, and how much notice must the practice provide?

Why the Number 50 Matters Under the Affordable Care Act

An employer with at least 50 full-time employees, including full-time-equivalent employees, on average during the prior calendar year is generally an applicable large employer. These employers become subject to federal employer shared-responsibility and information-reporting rules.[2]

The headcount is more specific than “50 people on payroll.” The Internal Revenue Service defines a full-time employee as someone averaging at least 30 hours of service per week or 130 hours per month. Part-time hours also feed into the full-time-equivalent calculation.[2]

A DPC or concierge membership does not remove those obligations. The membership addresses primary care. The employer's major medical plan and Affordable Care Act duties require a separate review.

Companies near the threshold should have their broker or benefits counsel calculate applicable-large-employer status before changing plan design. Common ownership across related businesses and seasonal-worker rules can change the count.[2]

The 2026 HSA Rule Helps DPC, With Limits

Beginning January 1, 2026, enrollment in certain direct primary care service arrangements no longer prevents an otherwise eligible person from contributing to a Health Savings Account (HSA). HSA funds can also pay qualifying periodic DPC fees tax-free.[6]

The rule has boundaries. The Internal Revenue Service defines a qualifying arrangement as primary care provided for a fixed periodic fee. The services must consist solely of primary care, with specific exclusions for procedures requiring general anesthesia, most prescription drugs, and laboratory services not typically given in an outpatient primary care setting. Monthly fees cannot exceed $150 for one person or $300 for an arrangement covering more than one person in 2026.[6]

Some concierge arrangements may fall outside that definition because of their price, insurance billing, or included services. Employers should ask the practice whether its contract qualifies as a direct primary care service arrangement under Internal Revenue Code Section 223. The benefits adviser should confirm the answer before describing the membership as HSA-compatible.

What the Savings Evidence Does and Does Not Prove

Employer-sponsored primary care has encouraging research behind it. The evidence does not guarantee savings for a specific 50-person company.

A 2020 JAMA Network Open study examined 23,518 employees and dependents at a Southern California engineering and manufacturing company. The employer offered on-site, near-site, and virtual comprehensive primary care. Members who used the program for most of their primary care had 45% lower adjusted total spending, equal to $167 less per member per month, and 33% lower emergency-department spending than matched controls.[7]

The study was observational. Program users may have differed from nonusers in ways the matching process could not measure. Only 2,305 people used the program for most of their primary care, and the matched analysis included 1,983 users and 1,983 controls. The authors specifically identified self-selection as a possible explanation for part of the spending difference.[7]

Hint Health reported another employer example in 2025. A national real estate company's DPC cohort averaged $282.08 per member per month, compared with $591.57 for its non-DPC cohort. Hint calculated a 52% difference and $360,000 in 2024 savings. The comparison included 98 DPC enrollees and 127 non-DPC enrollees and was not risk-adjusted.[5]

Those studies justify a measured pilot. They do not justify placing guaranteed savings in the contract.

A 50-person group should track:

• Enrollment and first-visit completion

• Time to the next available appointment

• Primary care visits per enrolled employee

• Urgent care and emergency-department use

• Employee-reported access and satisfaction

• Total claims, with protection against conclusions driven by one unusually large claim

For more detail on the downstream utilization evidence, see our analysis of emergency-department use among membership-primary-care patients.

Ten Questions to Put in the Contract Review

1. Who delivers the care? Confirm that the practice has a doctor of medicine (MD) or doctor of osteopathic medicine (DO) leading patient care.

2. How much capacity is reserved? Ask how many employees the practice can accept and what panel cap applies to each doctor.

3. What does the fee include? List office visits, virtual visits, messaging, after-hours access, physicals, basic procedures, and laboratory work.

4. What costs extra? Identify enrollment fees, medications, vaccines, outside labs, imaging, and specialist care.

5. Who qualifies? Define full-time employees, part-time employees, dependents, new hires, and employees who leave the company.

6. Where can employees receive care? Measure employee locations against actual practice locations. A network name alone does not establish access.

7. How does insurance interact with the membership? State whether the practice bills insurance and how referrals, prescriptions, and hospital care work.

8. What data will the employer receive? Limit reporting to the aggregate utilization and performance data needed to evaluate the benefit. Employee medical details belong with the patient and clinical team.

9. How does renewal work? Set the contract term, renewal notice, fee-change notice, cancellation rights, and treatment of employees receiving active care at termination.

10. Does the arrangement qualify for HSA treatment? Put the practice's answer in writing and have the employer's tax or benefits adviser review it.

A Practical Buying Process

For a company with 50 employees, the purchasing process can stay focused:

1. Map employee ZIP codes and identify the number of likely enrollees.

2. Decide whether you need one local practice or a multi-city network.

3. Request written proposals from at least two physician-led options.

4. Compare the service bundle, capacity, total annual cost, and employee travel time.

5. Have the broker and legal advisers review insurance, Affordable Care Act, HSA, tax, and employee-benefit questions.

6. Set a defined measurement period and decide what would support renewal.

Price matters, but unused access produces little value. The final selection should give employees a doctor they can realistically reach and a service bundle they understand.

FAQ

Which concierge medicine groups have employer contracts for 50 employees?

Local physician-led practices and DPC networks both offer employer contracts. Elizabeth Story MD publishes a $100-per-employee monthly plan, while Pulse Direct Care publishes one discount for groups of 11 to 49 and a larger discount beginning at 50 employees.[1][3]

How much does DPC cost for 50 employees?

Using NextMD's $50 to $200 monthly DPC range, employee-only coverage for 50 people would cost $30,000 to $120,000 per year. A real $100-per-employee monthly plan would cost $60,000 per year before any employee contribution.[1]

Does employer-sponsored DPC replace group health insurance?

No. DPC covers primary care services defined by the membership. Employees still need coverage for hospital care, surgery, specialists, and other large medical expenses.

Can employees use an HSA for the membership?

Employees can use HSA funds for qualifying direct primary care service arrangements beginning in 2026. The arrangement must satisfy the federal service, fee, and practitioner requirements, including the $150 individual or $300 multi-person monthly limit for 2026.[6]

Should a distributed company use a network?

A network can simplify contracting when employees live in several cities. The employer should verify physician availability around each employee cluster before signing because network coverage varies by location.

What should an employer measure during the first year?

Track enrollment, completed first visits, appointment access, primary care use, urgent and emergency care, employee feedback, and total claims. A 50-person population is small enough that one large claim can distort annual comparisons.

Find Physician-Led Practices for Your Workforce

NextMD lets employers compare concierge and DPC practices by location, model, doctor credentials, and published pricing. Start with the cities where your employees live, then ask shortlisted practices for their employer contract terms.

Search concierge and direct primary care practices on NextMD.

Sources

1. Elizabeth Story MD. (2026). Employer Solutions. Published employer price of $100 per employee per month with unlimited office and virtual visits. Read the employer plan

2. Internal Revenue Service. (2025). Determining if an Employer Is an Applicable Large Employer. Defines the 50-full-time-equivalent threshold and calculation. Read the IRS guidance

3. Pulse Direct Care. (2026). Employer Healthcare Solutions. Published group discounts of 10% for 10 or fewer employees, 15% for 11 to 49, and 20% for 50 or more. Read the employer options

4. American Academy of Family Physicians. (2024). Direct Primary Care Data Brief. Survey of 374 physicians, including 177 then practicing in DPC; 63% of DPC respondents participated in signed or formal employer contracts. Read the AAFP data brief

5. Hint Health. (2025). Employer Trends in Direct Primary Care 2025. Platform analysis covering more than 7,200 employer sponsors, 2,400 DPC clinicians, and 1.2 million members. Includes the 98-member DPC cohort and 127-member non-DPC comparison. Read the full report

6. Internal Revenue Service. (2026). Notice 2026-05: Expanded Availability of Health Savings Accounts Under the One, Big, Beautiful Bill Act. Defines qualifying direct primary care arrangements, HSA treatment, and 2026 fee limits. Read IRS Notice 2026-05

7. Basu, S., Zhang, T., Gilmore, A., Datta, E., & Kim, E. Y. (2020). Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model. JAMA Network Open, 3(4), e203803. Read the study