Membership Primary Care · Medicare Education
Direct primary care and Medicare: what to understand before you join anything
If you have Medicare and are considering a membership practice, you are right to be careful. This page is educational: it explains how a membership fee sits alongside Medicare, what no practice should promise you, and the exact questions to ask before you pay anyone. It is not a statement that Medicare covers Presence membership.
Educational information only · Presence does not bill Medicare for membership care · Coverage depends on your plan
The short answer
- Medicare, in one sentence
- People with Medicare can join a membership primary care practice, but the membership fee is a private fee paid by you. Presence does not bill Medicare for membership care, and we make no claim that Medicare reimburses it.
- Does Medicare pay the membership fee?
- Treat the answer as no unless your own plan documents say otherwise. A membership or access fee is generally not a Medicare-covered benefit, and it is not something any practice should promise on your behalf.
- Does joining affect your Medicare?
- Your Medicare stays yours. It continues to work for hospital, specialty, laboratory, imaging and other covered services from providers who bill it — membership does not replace or cancel it.
- What Presence will not tell you
- We will not name your coverage, predict your reimbursement, or state that our services are covered. Those depend on eligibility, the specific service, provider participation and your plan's rules.
- Next step
- Read the questions below, check them against your own plan documents, then decide.
This page sits under direct primary care — start there if you want the full picture first.
What can you do today?
- Compare memberships
You have Original Medicare
Membership is paid privately and does not replace Medicare. Keep your Medicare coverage for hospital and specialist care.
- Medicare and telehealth
You have a Medicare Advantage plan
Plans differ substantially. Your plan's rules must be verified before you rely on any coverage.
- Membership primary care
You want ongoing primary care now, regardless
Membership primary care with an adult-gerontology trained provider is available today, paid privately.
Presence is not currently able to bill Medicare. This page is educational and is not enrolment or benefits advice.
How a membership fee and Medicare actually relate
Medicare is insurance: it pays for covered services delivered by providers who participate in it and bill it. A membership fee is not a service — it is private payment for access, availability and time. Those are two different kinds of thing, which is why the answer to "does Medicare pay for it" is usually no, and why joining a membership practice does not affect your entitlement.
Where it gets genuinely complicated is what happens around the membership. Laboratory work, imaging, hospital care and specialty care are separate services delivered by separate providers, and whether those are billed to Medicare depends on who provides them and whether they participate. The only reliable answers come from your plan documents and the billing provider — not from a marketing page.
The membership fee
A private monthly fee you pay directly. Presence does not submit it to Medicare or to any insurer.
Your Medicare benefits
Unchanged by joining. They continue to apply to covered services from providers who bill them.
Everything else
Labs, imaging, hospital and specialty care are billed by those providers under their own arrangements.
Questions to ask any membership practice before you pay
Do you bill Medicare for anything?
You want a clear yes or no, in writing, not "we can look into it". At Presence, membership care is not billed to Medicare.
What exactly does the fee include?
Which visits are included, which are charged separately, and at what price. Get the numbers before agreeing to the term.
What am I still paying for elsewhere?
Ask specifically about labs, imaging, medications and specialty referrals, because that is where unexpected costs live.
What is the commitment?
Term length, billing frequency and what happens if your circumstances change. Presence membership is a 12-month commitment billed monthly.
Who this tends to suit, and who should think twice
Membership may be worth considering if
- You want longer, unhurried primary care visits and direct access
- You value seeing the same provider and having your medications reviewed properly
- You are comfortable paying a private monthly fee on top of the coverage you keep
It is probably not right if
- You are looking for something that reduces or replaces your Medicare costs
- Your care is primarily specialist-led or hospital-based
- A private monthly fee would strain your budget — in that case keep your covered primary care
Nothing on this page is coverage advice, and nothing here should be relied on in place of your own plan documents or a call to Medicare.
Questions people ask
Can I have Medicare and a direct primary care membership at the same time?
Yes. Keeping Medicare while paying privately for membership primary care is a common arrangement. Your entitlement is not affected by joining.
Will Medicare reimburse me for the membership fee?
Assume not. An access or membership fee is generally not a covered benefit, and we will not suggest you might be reimbursed.
Does Presence accept Medicare?
Presence does not bill Medicare for membership care. Whether any specific service could ever be billed depends on provider participation and plan rules, and we do not make participation claims we cannot substantiate.
What about Medicare Advantage?
The same logic applies, with plan-specific rules on top. Check your plan documents, because Advantage plans differ significantly from one another.
Is this legal advice or coverage advice?
No. This page is general education. For decisions about your own coverage, use your plan documents, your plan's member services, or Medicare directly.
Who would provide my care?
Local in-person primary care at Presence is provided by a board-certified Adult-Gerontology Primary Care Nurse Practitioner, for ages 13 and up. She is not a physician.
About this information
Written by the Presence care team for patients considering care with us. Presence care is delivered by licensed providers, including a board-certified Adult-Gerontology Primary Care Nurse Practitioner — not by a physician, and not by software. Meet your provider.
This page explains how our service works. It is general information, not a diagnosis, and it is not a substitute for an evaluation of your own situation. Whether testing, treatment or a prescription is appropriate is decided during a visit.
If this is an emergency — chest pain, trouble breathing, stroke symptoms, severe bleeding, or thoughts of harming yourself — call 911 or go to the nearest emergency department. See our emergency care notice.
Decide with the facts in front of you
Call and ask us anything about how membership works alongside the coverage you already have.