What concierge medicine costs in San Francisco

The prices, from the highest down

The highest published fee is $19,000 a year for Human Longevity's 100+ Concierge, which adds a dedicated concierge physician, a GRAIL cancer blood test, an MRI of body composition and consultations with subspecialists to the programme below it [1]. That programme, 100+ Care, costs $12,000 a year and includes a continuous glucose monitor, heart rhythm monitoring with a Zio patch, a low dose CT of the lungs, a cardiac MRI and a clinician follow up every quarter [1]. Human Longevity names San Diego and San Francisco as its locations [1].

Sollis Health sets its fees by age. Platinum costs $12,000 a year for a primary member under 45, $15,000 for one aged 45 to 60 and $17,000 in the oldest band, with lower fees for a second or additional family member [2]. Platinum includes 3 house calls a year for each member and CT and MRI scans when they are medically necessary [3].

Sollis Signature, the lowest published fee

Sollis Signature costs $4,000 a year for a primary member under 45 and $7,000 from 45 [2]. A second member pays $3,000 or $4,000 on the same age bands, and each additional member $2,500 or $3,000 [2].

Signature pays for visits at any Sollis centre, care by phone, text or video at any hour, routine blood tests with results often back in as little as 15 minutes, and an X-ray and EKG on site [2]. House calls and advanced imaging may cost extra on Signature. The San Francisco flagship keeps its doors open all day and all night, every day [4].

The practices that quote on request

Sutter Health charges a monthly fee for its San Francisco concierge practice and gives the figure when you call. You or your insurer also pay for billable care, and Sutter accepts plans that include Medicare. It notes that the membership fee may be tax deductible, which is worth raising with your tax adviser [5]. Private Medical, whose San Francisco office is in Pacific Heights, does not print a fee on its page either [6].

MDVIP says its annual fee depends on the area and the doctor, and each affiliated doctor's fee appears on that doctor's own page [7]. Whichever practice you consider, ask for the fee and a list of what it includes in writing before your first visit. These five points are worth comparing between any two fees.

• How many family members the fee covers, and what each extra member pays.
• Whether house calls, imaging and infusions are included or charged each time.
• Whether the practice bills your insurance for the medical care, and which plans it accepts.
• Whether the fee rises with age, and at which birthday.
• How much notice you must give to leave, and whether any part of the fee is refunded.

What the fee pays for, and what Medicare allows

A concierge fee pays for access, time and services that insurance does not cover. The medical care itself is billed on top or, at Sollis, paid by you, because Sollis does not bill insurance, including Medicare, for most services [2].

With Medicare, the fee has limits. In 2004 the Office of Inspector General warned that a participating doctor who asks a Medicare patient to pay extra for services Medicare already covers faces substantial penalties and exclusion from federal health programmes [8]. Its example was a $600 annual contract offering coordination of care and extra time, which it alleged were covered already, and the doctor settled and stopped offering it [8]. If you have Medicare, ask the practice to show you which services its fee pays for. The AMA asks every retainer doctor to explain how the contract affects your current insurance and to keep its charges clearly apart from insured care [9].

Whether a concierge fee pays for itself

The evidence is mixed. A study of Medicare patients with diabetes, built from MDVIP's enrolment lists and Medicare claims, compared those who enrolled with a matched group from the same local markets over 5 years [10]. Enrolment was linked to fewer emergency department visits and fewer unplanned hospital admissions. Total Medicare spending over the 5 years was not significantly different between the groups [10].

An earlier analysis by MDVIP researchers reported hospital discharges 79% lower among its Medicare members than among non-members by 2010 [11]. That study compared members with everyone else in five states, so some of the gap may reflect the kind of person who chooses to join. Judge a fee on the time and access you will use, and treat promised savings with care.

What our membership costs

Our founding membership in San Francisco is from $13,000 a year. It will pay for one doctor who looks after your whole family, sees you on the day you ask, and knows your history and your results.