Medicare Open Enrollment and Concierge Medicine: What Boca Raton Seniors Should Know
Medicare Open Enrollment
Open enrollment is the right time to rethink your doctor, too.
Medicare open enrollment runs October 15 to December 7 for 2027 coverage. Here is how concierge medicine fits your plan choices.
Medicare open enrollment is the one time each year you can change your Medicare coverage, and it is almost here. If you are a Boca Raton senior considering concierge medicine, or already a member of a concierge practice, you may be wondering how the two fit together. Here are straight answers to the questions we hear most.
When is Medicare open enrollment
When is Medicare open enrollment this year?
Medicare open enrollment, also called the Annual Election Period, runs from October 15 to December 7, 2026. Any changes you make during this window take effect on January 1, 2027.
During open enrollment you can switch from one Medicare Advantage plan to another, join or change a Part D prescription drug plan, or move between Original Medicare and Medicare Advantage. Your current plan should send you an Annual Notice of Change by the end of September describing what is different for next year. Read it carefully, because plans change every year: covered drugs, pharmacy networks, premiums, and provider networks can all shift.
Do I still need Medicare
Do I still need Medicare if I join a concierge practice?
Yes. A concierge membership is not health insurance, and it does not replace Medicare in any way. You still need your Medicare coverage for hospital care, specialists, prescriptions, lab work, imaging, and everything else outside the membership. Think of the membership as an addition to your coverage, not a substitute for it. Dropping Medicare to join a concierge practice would leave you exposed to the full cost of everything the membership does not include, which is nearly all of your medical care.
Does Medicare pay the concierge
Does Medicare pay the concierge membership fee?
No. Medicare does not cover concierge membership or retainer fees under any circumstances. The fee is paid out of pocket, entirely separate from your Medicare costs. This surprises some people, so it is worth stating plainly: your Medicare premiums, deductibles, and copays continue exactly as before, and the membership is an additional cost on top of them. When you budget for concierge care, budget for both.
How does billing work when
How does billing work when my concierge doctor participates in Medicare?
In the common hybrid model, the physician participates in Medicare and bills Medicare for covered office visits and services, just like a traditional practice would. The membership fee covers the extras that Medicare does not pay for: longer appointments, same-day or next-day access, direct access to your physician by phone or message, and preventive care planning.
You keep paying your copays and deductibles according to your plan, and if you carry a Medicare supplement, it continues to work as before for covered services. The practical effect is that your insurance experience barely changes; what changes is the time, access, and attention you get from your physician.
Should I choose Original Medicare
Should I choose Original Medicare or Medicare Advantage alongside concierge care?
Either can work with concierge care, and this is general guidance only, not plan-specific advice. The questions that matter are the ones you would ask anyway: are your preferred specialists and hospitals in the plan's network, how are your prescriptions covered under Part D, and what are your total expected out-of-pocket costs for the year?
Review your Annual Notice of Change before December 7, even if you are happy with your current plan, because next year's version of your plan may not be the same as this year's. For help comparing your options, talk to a licensed Medicare insurance agent or your State Health Insurance Assistance Program; in Florida, that free counseling program is called SHINE. And talk to your physician about your health needs for the coming year before you lock in a plan.
Is concierge medicine a good
Is concierge medicine a good fit for seniors on Medicare?
Honestly, seniors are among the patients who tend to get the most from it. Longer visits leave room to review multiple conditions and a full medication list without rushing. Prevention gets genuine attention instead of a checkbox. And care coordination matters more when several specialists are involved, which is common after 65.
The trade-off is real: the membership is an added out-of-pocket cost on top of premiums you already pay. If you see your doctor regularly, manage ongoing health issues, and value unhurried, coordinated care, the math often makes sense. If you rarely see a doctor and are fully comfortable with your current setup, it may not be worth it for you right now. Either answer is fine.
What should I ask a
What should I ask a concierge practice during open enrollment season?
Bring these questions to any practice you are considering: Do you participate in Medicare? How do you bill for covered visits, through Medicare or separately? Exactly what does the membership include, and what gets billed to Medicare on top of it? Can I keep my Medicare supplement? Get the answers in writing before you enroll, so there are no surprises in January.
About the author: This article was written by Dr. Abeer Aziz-Siddiqui, DO, a Board-Certified Internal Medicine Physician and Co-Founder and Chief Medical Officer of Palm Beach Concierge Medicine.
Keep Reading
Related guides from our practice
Does Insurance or Medicare Cover Concierge Medicine?
How Medicare treats concierge membership fees and covered services.
Related ReadingDo You Need a Primary Care Doctor in Boca Raton?
Why a dedicated primary care physician matters on Medicare.
Related ReadingConcierge Primary Care
Membership care designed around longer visits and direct access.
Frequently Asked Questions
Frequently asked questions
What is the Medicare open enrollment deadline?
October 15 to December 7, 2026, for coverage starting January 1, 2027. Changes made during this Annual Election Period take effect on New Year's Day. If you miss the window, you generally cannot change plans until the next fall, with limited exceptions for special enrollment periods.
Can I switch from Medicare Advantage to Original Medicare during open enrollment?
Yes. Open enrollment lets you move between Original Medicare and Medicare Advantage, switch Advantage plans, or join, change, or drop a Part D drug plan. Before switching, compare networks, drug coverage, and total costs, and confirm your doctors participate in the new plan. A licensed agent or Florida's free SHINE counseling program can help.
Do I still need Part D prescription coverage with a concierge doctor?
Yes. A concierge membership never includes prescriptions, so you still need drug coverage through Part D, a Medicare Advantage plan with drug coverage, or another source. Review your plan's formulary each fall during open enrollment, since covered drugs and pharmacy networks change from year to year.
Does the membership fee count toward my Medicare deductible or out-of-pocket maximum?
No. Because Medicare does not cover concierge membership fees, the fee does not count toward your Part B deductible or any out-of-pocket maximum. Only Medicare-covered services billed through your plan apply. Budget the membership as a separate, additional cost alongside your premiums, deductibles, and copays.
Will my Medicare supplement (Medigap) still work if I join a concierge practice?
Yes, for covered services. If your concierge physician participates in Medicare and bills Medicare for office visits, your supplement works as it always has, covering its usual share of deductibles and coinsurance. The supplement does not cover the membership fee itself. Confirm the practice's Medicare participation status before you enroll.
Where can I get free, unbiased help comparing Medicare plans?
Florida's State Health Insurance Assistance Program, called SHINE, offers free counseling to Medicare beneficiaries. You can also work with a licensed Medicare insurance agent. Avoid relying only on plan marketing materials; compare networks, drug formularies, and total yearly costs before the December 7 deadline.
Reviewing Your Coverage?
Make sure your doctor choice gets the same attention as your plan choice.
Schedule a free consultation with Dr. Abeer Aziz-Siddiqui, DO, Board-Certified Internal Medicine Physician, Co-Founder and Chief Medical Officer of Palm Beach Concierge Medicine.
This article is for general education and is not a substitute for individualized medical advice, diagnosis, or treatment. Coverage, insurance, and tax details can change and vary by plan; confirm specifics with your plan, physician, or a qualified advisor. If you are having a medical emergency, call 911.
