What $3,000 vs. Over $40,000 a Year Actually Gets You in Concierge Medicine: A 2026 Tier-by-Tier Guide

Concierge medicine in the United States runs from about $3,000 a year on the entry end to over $40,000 a year at the top.

Many patients see one of those numbers in a marketing brochure or a friend's anecdote and assume the rest of the category is priced near it, when in fact the category is more like four separate products with different patient profiles, different physician workloads, and different things included in the fee.

This guide walks through every tier, what is and is not included at each one, and which kind of patient each tier is built for. The numbers come from the NextMD canonical pricing reference, which tracks the actual fees published by the 4,649 concierge and direct primary care (DPC) practices listed on the platform.

The Four-Tier Landscape

Most concierge marketing collapses the market into a single price range. The reality is closer to four distinct tiers, each with its own service level.

Two notes on the panel-size numbers. The category-wide canonical figure for concierge medicine is "under 300 patients per doctor," and that is the right number to compare against the 2,000 to 2,500 patient panel of a traditional primary care practice.[1] Within concierge, panel sizes shrink as the price tier rises, which is the structural reason patients at the higher tiers get more time per visit and faster access between visits.

Tier 1: Direct Primary Care (DPC), $600 to $2,400 per year

DPC is the lowest-cost tier and one of the fastest-growing primary care models in the United States.[2] Memberships typically run $50 to $200 per month, or $600 to $2,400 per year, with a common band sitting at $75 to $150 per month.[2] At that price, most DPC practices include:

• Unlimited primary care visits during business hours

• Same-day or next-day appointments for acute issues

• Direct text, email, and phone access to the physician

• Basic in-office procedures (skin biopsies, joint injections, EKGs)

• Cash-pay or wholesale-priced lab work and imaging

• Basic chronic-condition management for diabetes, hypertension, asthma, thyroid disease, and similar conditions

• No insurance billing in most cases

What DPC typically does not include: specialist referrals coordinated end-to-end, comprehensive longevity workups, advanced diagnostic imaging in-house, or travel-ready medical support. DPC also does not bill insurance for visits, which means most patients pair a DPC membership with a high-deductible health plan to cover hospitalization and specialist care.

The published evidence on DPC outcomes is stronger than for any other tier. A 2020 Society of Actuaries and Milliman evaluation of DPC found that DPC patients used the emergency room about 40.51% less often than matched traditional-insurance patients, and total cost of care was lower despite the upfront membership fee.[3] The reduced emergency room use is the strongest single argument in favor of the DPC model for patients with moderate care needs. For a deeper look at how this tier compares to a standard insurance-based plan, see the NextMD comparison of DPC vs. traditional primary care.

Tier 2: Entry-Level Concierge, $2,500 to $5,000 per year

Entry-level concierge is the first tier that uses the word "concierge." Practices like The Cove Concierge Medicine in Castle Rock, Colorado or James Wallstrom, MD in Glendale, California sit in this band. At $200 to $415 per month, what is typically included:

• Everything in the DPC tier

• 24/7 access to the physician (often via personal cell phone)

• 30-to-60-minute appointments, with same-week (and often same-day) availability for urgent issues

• Insurance billing for covered services, so the patient's insurance plan still covers the medical care delivered during a visit

• Annual comprehensive physical with extended labs

• Coordination of specialist referrals

• Hospital visits when the patient is admitted (the concierge physician will often visit and coordinate with the inpatient team)

The difference between entry-level concierge and DPC is largely the insurance billing layer, the 24/7 access expectation, and the somewhat smaller panel size. A patient who already has good insurance and wants the additional access and time at a moderate price often lands in this tier. A patient who is happy paying cash for care and does not need 24/7 access often lands in DPC instead.

Tier 3: Premium Concierge, $5,000 to $12,000 per year

Premium concierge is a common tier among the larger concierge networks and many of the higher-end independent practices. At $415 to $1,000 per month, the practice can support a smaller panel and add services that the entry tier does not include. A representative example is WVL Synergy in Naples, Florida, which sits in this tier. What is typically included on top of the entry tier:

• In-house phlebotomy (blood draws done at the practice rather than at a separate lab)

• A nicer physical establishment. Often high-end design, specialized to make you feel comfortable

• Body composition scanning, often by dual-energy X-ray absorptiometry (DXA, a low-radiation imaging method that measures bone density, lean mass, and fat mass)

• Extended annual physical (often half a day) with imaging, advanced cardiac risk markers, and a detailed medical history review

• Care coordination across multiple specialists for patients with two or more chronic conditions

• Optional concierge nurse support for patients managing complex medications

• Often, in-house procedures the entry tier outsources, such as minor dermatology, joint injections, and intravenous (IV) fluid administration

Premium concierge is the right tier for patients with multiple chronic conditions, busy executives who need fast and longitudinal care, and patients who want a more thorough annual workup than the standard primary care physical provides. The practice typically still bills insurance for the medical services performed during a visit, and the membership fee covers the access, coordination, and extra time.

For a closer look at what the day-to-day inside a concierge practice actually feels like at this tier, see how concierge medicine actually works behind the scenes in 2026.

Tier 4: Ultra-Premium Concierge, $15,000 and up, commonly over $40,000 per year

Ultra-premium concierge is a distinct product, not just a more expensive version of premium. The named brands in this tier, including MD2 and Private Medical, routinely price above $40,000 per year per patient in top-tier markets like New York, Los Angeles, and San Francisco. What patients in this tier typically get on top of premium:

• Panels of fewer than 100 patients per physician (in some cases fewer than 50)

• Physicians who travel to the patient: home visits, hotel visits, office visits, hospital visits

• Coordination of the entire specialist network, including out-of-network specialists and academic medical centers

• Advanced imaging and diagnostic testing, sometimes including whole-body magnetic resonance imaging (MRI) and advanced cardiac imaging

• Genetic and longevity workups that go well beyond standard primary care

• Travel-ready medical support, including international care coordination

• Dedicated medical assistants and care managers, not just the physician

• In some cases, a multi-physician team built around the patient (primary care physician plus internist plus specialist on retainer)

A useful way to think about this tier is that the patient is buying not just the physician's time but the physician's logistical infrastructure. Patients at this tier are typically high-net-worth individuals, executives with complex schedules, or people managing complex multi-system care that does not fit inside a standard practice. For more on how this tier compares to the broader market, see the NextMD boutique doctors guide.

This tier is most commonly found in New York City, Los Angeles, and the Miami metro area. To browse practices in a specific market, search by city at nextmd.ai/search.

What Is Different Between Tiers (and What Is Not)

The honest framing of the tier ladder is that as the price rises, three things change:

1. Panel size shrinks. This is the structural lever. A doctor managing 800 patients has less time per patient than a doctor managing 100 patients, no matter how committed either physician is.

2. In-house services expand. Higher tiers handle more medical work inside the practice instead of sending the patient to a lab, imaging center, or specialist.

3. Logistical support deepens. At the higher tiers, the patient is not just buying a doctor, they are buying a coordinated team and infrastructure that handles scheduling, referrals, and travel.

Three things do not change across tiers:

• The fundamental physician-patient relationship. A good primary care doctor at a DPC practice and a good primary care doctor at an ultra-premium concierge practice are doing the same medical work in their visit. The difference is the time and infrastructure around the visit.

• The medical scope. All tiers practice primary care medicine, not specialty care. A cardiologist still treats your heart disease, a dermatologist still treats your skin, regardless of which concierge tier handles your primary care.

• The MD or DO requirement. Every practice in the NextMD directory has at least one MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) physician. Nurse practitioner-only and physician assistant-only practices fall outside the directory's scope.

Which Tier Fits Which Patient

A simple way to think about the choice:

A patient making the decision for the first time is usually well served by starting one tier below where they think they need to be, and moving up if the access falls short of expectations. Many patients overestimate how much in-house infrastructure they need and underestimate how much value a smaller panel size delivers.

For step-by-step help picking a doctor inside the tier you choose, see the NextMD guide to finding a concierge doctor near you.

The Insurance Question

A common misconception is that concierge medicine replaces health insurance. It does not, in any tier. Concierge and DPC fees cover the primary care relationship: the office visits, the time, the access, and the coordination. The patient still needs separate insurance to cover hospitalizations, surgeries, specialist care, imaging, prescription medications, and emergency room visits.

The most common pairing is a concierge or DPC membership plus a high-deductible health plan (a health insurance plan with a lower monthly premium and a higher annual deductible, typically pairing with a health savings account). The high-deductible plan handles the catastrophic and specialist care; the membership handles the day-to-day primary care.

A Note From the Author

I am not a doctor. Nothing in this article should be considered medical advice. This piece is a plain-language summary of the published fee structures across the concierge and direct primary care market in 2026.

NextMD helps you find and compare concierge medicine and direct primary care practices across the United States. Browse practices by city, compare pricing, and find a doctor who has time for you at nextmd.ai/search.

Sources

1. Mount Sinai Solutions. (2023). Concierge Care Isn't Just a Luxury. Mount Sinai Health System. Read on Mount Sinai Solutions. Referenced for concierge panel-size benchmarks and the institutional concierge program context.

2. Hint Health. (2025). Employer Trends in Direct Primary Care 2025. Hint Health. Download the Hint Health Employer Trends report. Referenced for DPC membership fee distributions and employer-DPC adoption data.

3. Busch, F., Grzeskowiak, D., & Huth, E. (2020). Direct Primary Care: Evaluating a New Model of Delivery and Financing. Society of Actuaries / Milliman. Read the full report on SOA.org. Referenced for the 40.51% emergency room reduction in DPC patients and the total cost of care comparison.