What is the difference between concierge medicine and direct primary care?

Both models charge patients a recurring membership fee instead of relying on insurance billing for primary care. Direct primary care (DPC) is typically $50 to $150 a month with panels of 400 to 600 patients, and focuses on affordable access to routine care. Concierge medicine typically costs $200 to $2,500 a month with panels of 50 to 600 patients, and adds deeper preventive testing, extended visits, and 24/7 physician access. The practical difference is panel size and how much diagnostic medicine happens inside the practice.

Is direct primary care cheaper than concierge medicine?

Yes, almost always. Direct primary care usually runs $600 to $1,800 per year, while concierge memberships commonly run $2,000 to $30,000 per year. The tradeoff is that DPC panels are larger and advanced diagnostics are generally referred out and billed separately rather than included.

Do concierge medicine and direct primary care replace insurance?

Neither replaces insurance. Both cover the primary care relationship only. You still need coverage for hospitalization, surgery, specialists, emergency care, and prescriptions. Many DPC patients pair the membership with a high-deductible plan.

Concierge Medicine vs. Direct Primary Care: The Real Difference

Concierge medicine and direct primary care are variations on the same idea: you pay your physician directly, and in exchange the physician takes fewer patients. The practical differences come down to three things. Direct primary care usually costs $600 to $1,800 a year with panels of 400 to 600 patients. Concierge medicine usually costs $2,000 to $30,000 a year with panels of 50 to 600. And concierge practices tend to perform advanced diagnostics inside the practice, where direct primary care refers them out.

Neither replaces insurance. Both fix the same underlying problem.

The problem both models are solving

A primary care physician working inside the insurance system typically carries 1,900 to 2,500 patients. The economics only work at volume, so the visit gets compressed to fifteen minutes and the schedule gets booked out for weeks.

That is not a failure of individual doctors. It is arithmetic. Fifteen minutes is enough time to address the complaint that brought you in. It is not enough time to look at the whole picture, and it makes proactive medicine practically impossible.

Both direct primary care and concierge medicine break that arithmetic the same way: remove insurance billing from primary care, charge the patient directly, and use the revenue to cut the panel.

Direct primary care

DPC practices generally charge $50 to $150 per month. A 2020 Society of Actuaries study of direct primary care put the average panel at 445 patients, with practices targeting about 628. Call it 400 to 600, which is a large improvement over 2,000 but still a real workload.

What you get: same-week or same-day appointments, 30 to 60 minute visits, direct messaging with your physician, and often wholesale-priced labs and generic medications dispensed at cost. Many DPC practices are genuinely excellent at this, and the model is one of the more encouraging developments in American primary care.

What you generally do not get: whole-body imaging, advanced cardiovascular screening, or a structured preventive program. Those exist, but they are referred out and billed separately.

DPC pairs well with a high-deductible health plan. The membership handles routine care efficiently, the insurance handles catastrophe.

Concierge medicine

Concierge practices generally charge $200 to $2,500 per month, and panels vary enormously across that range, which is exactly why the price does too.

At the lower end, around $2,000 to $4,000 a year, the model is close to DPC with a longer annual physical. At the higher end, panels drop to 50 to 100 families and the practice takes on work that would otherwise be spread across several specialists: advanced imaging, cardiovascular risk stratification, metabolic testing, cancer screening, and genetics.

What you also get, and what is hard to price: continuity. The same physician, reachable directly, who has seen your numbers move over years rather than reading a chart for the first time.

The comparison, side by side

	Direct primary care	Concierge medicine
Typical cost	$600 to $1,800 per year	$2,000 to $30,000 per year
Typical panel	400 to 600 patients	50 to 600 patients
Visit length	30 to 60 minutes	60 to 120 minutes
After-hours access	Usually by message	Usually direct, 24/7
Advanced diagnostics	Referred out, billed separately	Often included
Insurance billed for primary care	No	No
Still need insurance	Yes	Yes

The ranges overlap at the edges, and some practices are honestly hard to categorize. The label matters less than the specifics.

Where Kosmos sits

Kosmos is a concierge practice, and a deliberately small one. Each of our three physicians holds a panel of 100 families.

Premium Care is $575 a month, which is $6,900 a year: the full primary care relationship, same-day or next-day appointments, 24/7 direct physician access, and extended annual visits.

Optimal Care is $1,250 a month, which is $15,000 a year, and adds the diagnostics program: whole-body MRI, coronary CT angiography, VO2 max testing, DEXA, continuous glucose monitoring, advanced cancer screening, and genetics.

Children of members aged 15 to 29 join for $200 a month.

We are not the cheapest option in Seattle and we do not try to be. If what you need is affordable, unhurried routine care, a good direct primary care practice will serve you well and cost a fraction of this. If what you want is a physician with the time and the tools to look for problems before they announce themselves, that is the practice we built.

How to choose between them

Ask yourself what you actually want to change about your current care.

If the answer is “I want to be able to see my doctor,” direct primary care solves that at a much lower price.

If the answer is “I want someone to be genuinely proactive about my health, with real testing behind it,” that generally requires a smaller panel and a diagnostics program, which is the concierge end of the range.

If you are not sure, the panel number is the fastest way to tell what a practice can actually deliver. Ask it first, of every practice you consider.