How Concierge Medicine Works With Insurance, HSA/FSA, and Taxes in St. Louis

One of the most persistent misconceptions about concierge medicine is that it replaces insurance entirely—or that membership fees somehow negate the benefits already available through an existing health plan. Neither is true. At Three Rivers Concierge Medicine in Creve Coeur, the concierge membership fee covers enhanced access, time, and continuity with Dr. Kathryn Shoemaker, while insurance continues to function exactly as it always has for labs, imaging, prescriptions, specialists, and hospital care. Understanding how these financial layers work together—and how HSA, FSA, and tax considerations factor in—makes the decision to switch far less complicated than many assume.

Concierge Membership Fees and Insurance: Two Separate Financial Layers

The monthly membership fee at TRCM is approximately $225. This covers the infrastructure that traditional insurance does not: extended visit times (30 to 60 minutes), same-day or next-day appointments, direct phone and text access to Dr. Shoemaker, proactive health strategies, and the bandwidth for genuine continuity of care. According to the American Medical Association, the average primary care physician manages a panel of approximately 2,300 patients, making it nearly impossible to provide individualized, unhurried attention. The concierge model inverts that ratio, allowing Dr. Shoemaker to maintain a significantly smaller panel and dedicate the clinical time each member deserves.

Insurance still covers medically necessary services—labs, imaging, medications, specialist referrals, and hospitalization—just as it did before joining a concierge practice.

The membership fee does not replace insurance. It supplements it. When Dr. Shoemaker orders bloodwork, a chest X-ray, or refers a member to a cardiologist, those services are billed to the member's insurance carrier in the standard way. The concierge fee ensures the quality of the relationship and the time to interpret results thoughtfully, coordinate care across specialists, and adjust health strategies based on comprehensive data—not the tests themselves.

What the Membership Fee Covers vs. What Insurance Covers

Clarity on what each payment stream supports is essential. The concierge membership at TRCM includes:

• Unlimited office visits with no additional co-pays for those visits
• Extended appointment times for thorough evaluation and discussion
• Same-day or next-day appointment availability
• Direct communication with Dr. Shoemaker via phone, text, or email
• Coordination of care across specialists and hospital systems
• Proactive management of chronic conditions and preventative medicine strategies
• Annual executive physicals that go far beyond standard screenings

Insurance continues to cover:

• Laboratory testing and diagnostic imaging
• Prescription medications
• Specialist consultations and procedures
• Hospitalization and inpatient care coordination
• Durable medical equipment
• Emergency and urgent care outside the practice

This dual structure means that members are not paying twice for the same service. They are investing in a level of primary care access and expertise that high-volume, insurance-driven practices cannot structurally provide.

Using HSA and FSA Funds for Concierge Membership Fees

One of the most underutilized advantages for individuals considering concierge medicine is the ability to pay membership fees using Health Savings Account (HSA) or Flexible Spending Account (FSA) funds. According to the Internal Revenue Service, concierge medicine fees are generally considered eligible medical expenses when the practice provides substantive medical care beyond convenience services. At TRCM, the membership structure qualifies because it includes comprehensive primary care services, chronic disease management, and preventive care coordination—not merely expedited scheduling or amenities. Members with HSA or FSA accounts can typically use pre-tax dollars to cover the monthly membership fee, effectively reducing the after-tax cost by their marginal tax rate. For someone in the 24% federal tax bracket, that translates to a real cost of approximately $171 per month instead of $225.

Using HSA or FSA funds for concierge membership fees allows members to pay with pre-tax dollars, significantly lowering the effective monthly cost.

It is advisable to confirm eligibility with the HSA or FSA plan administrator, as plan-specific rules can vary. TRCM provides documentation of services covered under the membership to support reimbursement or direct payment from these accounts.

Tax Deductibility of Concierge Medicine Fees

For individuals who itemize deductions, concierge medicine membership fees may be deductible as a medical expense under IRS guidelines. According to IRS Publication 502, medical expenses that exceed 7.5% of adjusted gross income (AGI) can be deducted. This threshold means that for most people, the membership fee alone will not trigger deductibility unless combined with other significant out-of-pocket medical costs throughout the year. However, for members managing chronic conditions, undergoing treatment, or accumulating substantial medical expenses through specialists, hospitalizations, or prescriptions, the concierge membership fee can contribute to reaching that threshold. The IRS defines deductible medical expenses broadly to include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease—criteria that internal medicine and preventive care clearly meet. TRCM provides an annual summary of membership payments upon request to facilitate tax filing. Consulting a tax professional familiar with medical expense deductions is recommended to ensure compliance and optimization.

How This Compares to Traditional Primary Care Costs

The comparison between concierge membership and traditional insurance-based care is not as simple as tallying co-pays. The hidden costs of conventional primary care—repeated visits for issues that could be resolved in a single longer appointment, delayed diagnoses due to rushed evaluations, poor medication management leading to adverse reactions or hospitalizations—add up in ways that rarely appear on a balance sheet. Research published in The Journal of the American Board of Family Medicine has shown that shorter visit times correlate with higher rates of diagnostic errors and lower patient satisfaction. When primary care visits average 15 minutes or less, complex cases are either deferred or inadequately addressed, often resulting in emergency room visits, specialist consultations that could have been avoided, or progression of manageable conditions into crises. At TRCM, the investment in membership reduces these downstream costs. Members report fewer urgent care visits, more effective management of chronic conditions like hypertension and diabetes, and better coordination when specialist care is necessary—all of which translate to both financial savings and improved health outcomes over time.

How Insurance Continues to Work Seamlessly

TRCM is affiliated with major St. Louis hospital systems including Mercy, Missouri Baptist, and Barnes Jewish, and Dr. Shoemaker works within those networks to coordinate care when hospitalization or specialist referrals are needed. Insurance claims for covered services are submitted in the standard manner, and members continue to benefit from negotiated rates, deductibles, and out-of-pocket maximums as outlined in their existing plans. For members with high-deductible health plans (HDHPs), the concierge model can be particularly advantageous. These plans often pair with HSAs, allowing the membership fee to be paid with pre-tax funds while the HDHP covers catastrophic and high-cost care. The enhanced preventive focus at TRCM—supported by tools like advanced testing and screenings, pharmacogenomic testing, and body composition analysis—can help members avoid the expensive complications that high-deductible plans are designed to address.

What About Medicare and Medicaid?

Medicare beneficiaries can join a concierge practice, but there are specific regulations that apply. According to the Centers for Medicare & Medicaid Services, concierge practices must either opt out of Medicare entirely or structure their fees to avoid duplicating services already covered by Medicare. TRCM operates in a way that allows Medicare members to participate while remaining compliant with federal guidelines. Medicaid reimbursement structures generally do not align with the concierge model, and most concierge practices, including TRCM, do not accept Medicaid. For individuals covered by employer-sponsored plans, Affordable Care Act marketplace plans, or private insurance, the concierge membership integrates smoothly.

Making the Financial Decision With Full Information

The choice to invest in concierge medicine is fundamentally a decision about how healthcare dollars are allocated. For many individuals and families in the St. Louis metro area, the frustration with traditional primary care—brief visits, difficulty securing appointments, lack of personalized attention—represents a hidden cost in both health and time. The question is not whether concierge care costs more in absolute terms, but whether the value provided justifies the cost when all factors are considered. When HSA or FSA funds are used, the effective monthly investment is lower than the nominal fee. When the membership prevents a single emergency room visit, catches a condition early enough to avoid specialist intervention, or provides the continuity necessary to optimize medication regimens and avoid adverse effects, the return becomes measurable. TRCM does not position itself as a luxury service for the ultra-wealthy. It is a structural correction to a healthcare system that has deprioritized time, continuity, and prevention in favor of volume. The financial model is designed to be accessible to educated professionals, families, and individuals who recognize that their health deserves more than what high-volume practices can offer.

If the financial structure of concierge medicine and how it integrates with insurance, HSA/FSA accounts, and tax planning is clearer now, the next step is a conversation about how this model applies to individual health goals and circumstances. Schedule a complimentary consultation with Dr. Shoemaker at (314) 744-5914 or reach out info [at] threeriversmedicine.com (via email) to discuss how concierge care could change the trajectory of health management.

Sources

1. American Medical Association
2. Internal Revenue Service
3. IRS Publication 502: Medical and Dental Expenses
4. The Journal of the American Board of Family Medicine
5. Centers for Medicare & Medicaid Services