A concierge practice quoted you $15,000 to $20,000 a year and you liked almost everything about it except the invoice. How is this different from concierge medicine at $20,000? The clinical relationship is built on the same idea, a named physician who knows you and reads your labs, but the membership delivers it for $299 a month through telehealth and direct primary care and it is scoped to cardiometabolic health rather than to everything. The differences that matter are scope, price and what each one leaves out and this page sets them side by side.
- We would rather name this than compete on a flattering slide.
- The first advantage is the cadence of data.
- The prescribing side of the membership is the same branded medication a concierge practice would write and the evidence base is public.
- The concierge retainer suits the reader who wants in-person medicine across the whole of primary care and is comfortable paying for the building and the panel size.
- Not everyone is accepted and the acceptance belongs to the clinical team.
What the $20,000 actually buys and why it costs that
Traditional concierge and retainer practices charge roughly $1,500 to $3,200 a year in most of the country and reach far higher figures in a few coastal metros, with the top of the market selling executive physicals and deep panels at five and six figures. The price is not a scam. It buys the physician's time in person, a small panel of patients, same-week or same-day access and a level of service that insurance reimbursement alone cannot fund. Over 75 percent of longevity-clinic patients are Gen X and the market is largely self-pay, which tells you who the price is aimed at.
What the retainer usually buys in clinical terms is access and attention. What it often does not buy is the system we are built around, which is the quarterly biomarker picture read against optimal ranges and the prescribing that follows it. Some concierge practices run excellent panels. Others hand you a spiral binder and a pat on the back. The price guarantees the appointment and not the system.
| What you are buying | Concierge at $20,000 | The $299 membership |
|---|---|---|
| The relationship | A named physician, in person, small panel | A named clinician, video and messaging, licensed in your state |
| The cadence | Visits when you book them | A Biomarker Audit every 90 days and monthly check-ins |
| The labs | Varies widely by practice | ApoB, Lp(a), hs-CRP, HbA1c, lipids, insulin markers and full hormone and thyroid panels, included four times a year |
| The prescribing | Practice dependent | Branded and FDA-approved GLP-1 and hormone therapy when indicated, billed by your pharmacy at its price |
| The scope | Whole-person primary care | Cardiometabolic and hormonal care. A broken elbow is not this product |
| The bill | $20,000 a year, often up front | $598 held at sign-up and charged only at acceptance, then $299 a month, cancel any time |
Where the membership is the weaker product
We would rather name this than compete on a flattering slide. If you want hands-on physical examinations, in-person procedures, a physician who sees your face twice a quarter and coordinates your specialists over lunch, a good concierge practice delivers things telehealth cannot. If you have complex multisystem disease, you need a local medical home and possibly a local specialist and neither of us is the substitute for the other.
The honest scoping goes further. We treat the cardiometabolic and hormonal system. We do not manage your orthopedics, your dermatology or your acute care and we do not replace insurance. The membership pairs with insurance for the hospital and the catastrophic and replaces the primary-care relationship, never the coverage. If you are looking for one $299 purchase to handle everything medicine can throw at you, that product does not exist at this price anywhere and we will not pretend otherwise.
Where the membership is the stronger product
The first advantage is the cadence of data. A concierge physical is an annual event. Our diagnostic layer is a Biomarker Audit every 90 days, read against optimal ranges rather than population averages, so the protocol is rewritten four times a year while your biology is still moving. A1c drifting across two consecutive audits, ApoB falling as your protocol takes hold, a thyroid dose adjusted on the trend and not on a single result, these are visible only when the data is quarterly.
The second advantage is the incentive structure and this is the one worth dwelling on. A $20,000 retainer is paid whether or not your outcomes move and the practice has no arithmetic reason to care which way they go. Our revenue is the membership and the membership renews on your results. We earn nothing on the medication, which is prescribed to the pharmacy you choose and billed by that pharmacy at its own price. One flat fee for the doctor. Zero markup on the medicine. Dose minimization is rewarded here because a lower dose costs you nothing and us nothing and deprescribing when your labs support it is a success rather than a lost sale.
The third advantage is simply the price. The concierge retainer at the top of the market runs about $20,000 a year. Twelve months of this membership is $3,588 and twenty-four months is $7,176 with eight audits included. The question is not whether the $299 product is better than the $20,000 product at everything. It is whether the four things we do well, the quarterly labs, the clinician who stays, the prescribing without markup and the portal that keeps your story in one place, are the four things you were shopping for.
The evidence behind the clinical layer
The prescribing side of the membership is the same branded medication a concierge practice would write and the evidence base is public. In STEP 1, adults with overweight or obesity who took semaglutide 2.4 mg lost about 15 percent of body weight on average over 68 weeks. In SURMOUNT-1, tirzepatide produced average losses of up to about 21 percent over 72 weeks. Those are trial averages under supervision. Individual results vary and no honest clinic promises a number on the scale. The difference is not the molecule. It is that the molecule is prescribed off a quarterly panel and a named clinician's protocol, on a fee that never rises with the dose.
Who each one is actually for
The concierge retainer suits the reader who wants in-person medicine across the whole of primary care and is comfortable paying for the building and the panel size. There is no version of this page where that is a bad choice for the person who wants it.
The membership suits a different reader. You have a high-deductible plan and pay out of pocket anyway. You read ApoB and Lp(a) on your own labs and nobody has connected them to your weight, your sleep and your hormones. You have been prescribed things before and never understood why. You want the testing before the treating and you do not want the fee to grow with the prescription. If the concierge quote is the alternative in your head, the honest comparison is the scope column and the price is what you pay for giving up the parts of concierge care you were never going to use.
This is also not for everyone. It is not for the reader who wants a prescription today without labs. It is not for anyone seeking compounded GLP-1, which we never prescribe under any circumstance. And it is not for the reader who needs a doctor in the room.
Check whether you qualify
Not everyone is accepted and the acceptance belongs to the clinical team. The path is the eligibility check, the intake, the checkout and then a clinician's review and nothing is charged until your clinician accepts you. If the $598 hold is the open question, our piece on cancelling the membership and the refund rule states both halves in full. The eligibility check takes about two minutes.
FAQ
How is this different from concierge medicine at $20,000?
Concierge at that price buys in-person, whole-person primary care with a small patient panel. The $299 membership buys a named clinician, a Biomarker Audit every 90 days and cardiometabolic prescribing without markup, delivered by telehealth, scoped to metabolic and hormonal health.
Is the membership a cheaper version of the same thing?
It is a different product with a different scope. It replaces the annual-panel-and-reassurance model with quarterly labs and a protocol that changes with them and it does not include in-person care or acute visits.
Does the membership replace my insurance?
No. It pairs with insurance for the hospital and the catastrophic and replaces the primary-care relationship, never the coverage.
Does the fee change with my prescription?
No. The fee is $299 a month whatever medication is indicated and whatever the dose. Medication is billed by your pharmacy at its own price and nothing is added by us.
What does a year of membership cost?
Twelve months total $3,588, the $598 first payment plus ten months at $299. Twenty-four months total $7,176 and include eight Biomarker Audits.
Can I use the membership alongside my concierge doctor?
Some members do and the honest note is to tell both clinicians what the other is prescribing. If you want one clinical relationship rather than two, choose one and let the labs decide.
One last thing
The $20,000 question is really a question about what you are paying for. If it is the room and the ritual, pay for the room. If it is being known, being measured and being prescribed from your own data by a clinician with no reason to upsell you, that part costs $299 a month.
Related Guides
- The definitive guide to Cardiometabolic Optimization
- Direct primary care at GoodLife Health
- What $299 a month actually buys over 24 months
Sources: Direct Primary Care: Practice Distribution and Cost Across the Nation, STEP 1 and SURMOUNT-1. Concierge pricing hedged from published market surveys, October 2026.
References
- Direct Primary Care: Practice Distribution and Cost Across the Nation (J Am Board Fam Med). 2015. pubmed.ncbi.nlm.nih.gov/26546651/
- Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). 2021. pubmed.ncbi.nlm.nih.gov/33567185/
- Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). 2022. pubmed.ncbi.nlm.nih.gov/35658024/