1. The short answer
The defining difference is insurance. A direct primary care practice typically does not bill insurance at all and is paid only by the membership fee. A concierge practice often keeps billing insurance for covered visits and charges a retainer on top for what insurance does not cover. Almost everything else follows from that.
| Concierge medicine | Direct primary care | |
|---|---|---|
| Insurance billing | Often kept for covered services | Typically none |
| How the fee is billed | Often an annual retainer | Usually monthly |
| Fee level | Higher | Lower |
| Panel size | Smaller | Larger, though still well below conventional panels |
| Typical patients | Often higher-income members paying for more access | A broader income range, sometimes through employers |
| Regulatory focus | Payer contracts and Medicare billing rules | State insurance law and, since 2026, HSA rules |
The labels are not regulated terms, and plenty of practices sit between the two: a DPC practice that bills one payer, or a concierge practice that has stopped billing insurance altogether. What matters for your software is not the label but the answers to two questions: do you bill insurance, and how is the fee charged?
2. Fees and panel sizes
The figures below are commonly reported ranges, not benchmarks, and individual practices vary widely.
| Concierge medicine | Direct primary care | |
|---|---|---|
| Commonly reported fee | Roughly $1,500 to several thousand dollars a year per adult | Roughly $50 to $100 a month per adult |
| Billing cycle | Annual is common; monthly and quarterly also used | Monthly is common |
| Commonly reported panel | Roughly 300 to 600 members per physician | Several hundred members per physician, often more than concierge |
| Other revenue | Insurance for covered visits, where billed | Sometimes in-house dispensing or labs passed through at cost |
The arithmetic is different in kind. A concierge practice earns more per member and carries fewer of them, and may add insurance revenue. A DPC practice earns less per member, carries more, and has no claims revenue or claims cost. Both depend on keeping members, which is why renewal and failed-payment handling matter so much in the software. For the launch-side arithmetic, see how to start a concierge medicine practice.
3. How regulators treat each model
This is an outline of where the questions are, not legal or tax advice. Take your specific setup to a healthcare attorney and a tax advisor, and check your own state.
| Question | Concierge medicine | Direct primary care |
|---|---|---|
| Medicare | The HHS Office of Inspector General has warned that a fee charged to Medicare patients only for access to covered services can count as double billing. Practices that stay enrolled generally build the retainer around non-covered services. | Some DPC physicians opt out of Medicare and sign private contracts with Medicare patients, under CMS rules with two-year opt-out periods that now renew automatically. |
| State insurance law | Depends on the state and how the retainer is structured | Many states have passed laws treating a DPC agreement as outside insurance regulation, usually with conditions. Not all have. |
| HSAs | Whether a retainer on top of insurance billing qualifies for the new HSA treatment is a question for a tax advisor | From 1 January 2026, the IRS says enrollment in a qualifying DPC arrangement no longer by itself blocks HSA contributions, and HSA funds can pay the fee, within monthly limits |
| Payer contracts | Commercial contracts may limit what you can charge members on top | Not relevant if you bill no payer |
On the HSA point, the IRS limit for 2026 is $150 a month for an individual and $300 a month for an arrangement covering more than one person, adjusted for inflation after 2026. The definition centers on primary care paid for by a fixed periodic fee and leaves out most prescription drugs, procedures needing general anesthesia, and lab services beyond what a primary care office typically handles. Fees above the limit can still be paid from an HSA as a medical expense, but the IRS says the member then cannot contribute to the HSA while enrolled. If your fee sits near the line, that is worth knowing before you price.
4. What changes in your software
Most of the clinical software is the same for both models. The billing side is where they diverge, and it is where choosing the wrong product costs the most.
| Area | Concierge medicine needs | Direct primary care needs |
|---|---|---|
| Membership billing | Annual retainers, often with monthly or quarterly options | Reliable monthly billing at volume; failed cards caught fast |
| Included services | Annual physical and a set of visits or benefits, counted when used | Often unlimited office visits; count them anyway, to see use |
| Family plans | Common for households | Common, sometimes with separate pricing for children |
| Insurance claims | Eligibility, claims from the encounter, remittance posting, if you bill | Usually none |
| Superbills | For services you do not bill directly | So members can seek reimbursement themselves |
| Payer and Medicare setup | Payer enrollment, which takes weeks | Usually none; opt-out paperwork if you choose it |
| Messaging and telehealth | Central to the access you are selling | Central, and higher volume across a larger panel |
| Dispensing and labs at cost | Less common | Common; inventory and lot tracking matter |
| Employer arrangements | Less common | Sometimes; check how a vendor bills an employer, if you need it |
The practical consequence: a DPC practice should not pay for, configure or maintain an insurance module it will never use, and a concierge practice that bills insurance should not run claims in a separate tool from the retainer. Either mismatch means reconciling two systems by hand every month. For the billing mechanics in detail, see concierge medicine membership billing.
5. Where Aminova fits for each model
Aminova is built cash-pay first, with insurance as something you switch on. That suits a DPC practice as it stands, and suits a concierge practice that bills insurance once the add-on and its payer enrollments are in place.
| Concierge medicine | Direct primary care | |
|---|---|---|
| Memberships | Plans you compose, billed monthly, quarterly or annually; included visits counted at check-in | The same, with family plans billed once and a separate chart per member |
| Insurance | Add-on: real-time eligibility, claims built from the encounter, remittances posted back; priced on claim volume | Not needed; superbills are included on every plan |
| Access | Patient messaging from the app on the chart; telehealth included in Prescribing | The same; a virtual visit can count against a membership allowance |
| Dispensing | Available if you dispense | In-house dispensing from your own stock, with lot and expiry on the record |
| Labs | Saved panels and printed requisitions; results uploaded or entered, then trended | The same; no electronic connection to any lab |
| Price | Prescribing: $99/mo for the first 3 months for new clinics billed monthly, then $199/mo; +$99/mo per extra prescriber; $250 activation | The same; your whole team is included, month-to-month |
Two limits apply to both. We do not connect to labs electronically, and we do not publish a feature for billing employers directly, so if your DPC model depends on employer contracts, ask us how that would work before you commit. For the EMR bill in more detail, see what a concierge medicine EMR costs.
6. Frequently asked questions
What is the main difference between concierge medicine and direct primary care?
Insurance. A direct primary care practice typically does not bill insurance and is paid only by the membership fee. A concierge practice often keeps billing insurance for covered services and charges a retainer on top.
Is direct primary care cheaper than concierge medicine?
Usually. Commonly reported DPC fees run roughly $50 to $100 a month per adult, while concierge retainers commonly run from roughly $1,500 to several thousand dollars a year. Panels are larger in DPC to compensate.
Can I use an HSA to pay for direct primary care?
From 2026, the IRS allows HSA funds to pay for qualifying DPC arrangements, and enrollment no longer by itself blocks contributions, if the fee stays within $150 a month for an individual or $300 for more than one person. Check the details with a tax advisor.
Does a DPC practice need an EMR with insurance billing?
Usually not. It needs reliable membership billing, superbills members can submit themselves, messaging, telehealth and e-prescribing. Paying for an insurance module you never use adds cost and setup for nothing.
Can one EMR handle both concierge and DPC members?
Yes, if it lets you compose different plans on different billing cycles and switch insurance billing on only where you use it. Ask to see both plan types on the same patient list in a demo.