If you’ve reached financial independence and you’re rethinking your health insurance setup, you’re not alone. A question I hear often from people in the $10 million-plus range goes something like this: “We’ve left traditional employment, we have a catastrophic plan, and we’re considering concierge medicine. Does this make sense?” The short answer is: concierge medicine, yes. But the underlying insurance structure deserves a closer look.
Concierge Medicine Is Not an Insurance Decision
The first thing to understand is that concierge medicine and health insurance are two separate decisions. Adding a concierge practice with a joining fee and an annual retainer is not a risk transfer move. You are not changing your coverage — you are upgrading the quality and personalization of your care. Longer appointments, direct physician access, fewer hoops to jump through. That is the value proposition, and it is a reasonable one, especially at higher levels of net worth.
I do not see any inherent issue with layering concierge medicine on top of a high-deductible plan. In fact, it is a very common approach for families above $10 million in invested assets. The two serve different purposes and can work well together.
A $25,000 Deductible Is Not the Problem
A $25,000 deductible on a catastrophic plan is not a concern at this asset level. For a household with $11 million in investments, $25,000 can be a rounding error. You are self-insuring for routine and moderate medical costs, and that is a perfectly rational strategy. The deductible alone should not raise any red flags.
The Coverage Cap Is the Real Risk
Here is where things get serious. A $1 million coverage cap on a health plan tells me this is almost certainly not an ACA-compliant plan, because ACA-compliant plans cannot legally impose lifetime or annual coverage caps. What you are likely dealing with is something I would call a “healthcare adjacent” product, most commonly a health sharing ministry.
Health sharing ministries work by pooling risk among members. You submit your medical expenses, and other members cover them. They cover yours in return. It sounds appealing, but there is a critical flaw: there is no legal obligation for the group to pay. These arrangements are not insurance. They often come with coverage caps, just like the million-dollar cap in this scenario, and no regulatory protection if claims go unpaid.
Running the Real Numbers on Catastrophic Risk
When evaluating any insurance decision, you have to think about two things simultaneously: the probability of an event and the financial severity if it happens. For low-probability, high-severity events, the instinct should be to insure, not self-insure. Think of it like flood insurance. You buy it not because flooding is likely, but because the financial damage if it happens would be devastating.
A $350,000 hospital bill? A $900,000 cancer treatment? At $11 million, those are survivable. But three to four million dollars of multi-year care for a serious chronic condition? That is a different story. That kind of expense can move fast through an $11 million portfolio. And a $1 million cap means you would blow through your coverage well before the bills stop.
That is the gap this structure leaves wide open. And it is not a small gap.
What a Cleaner Structure Actually Looks Like
If the goal is to minimize premiums while avoiding catastrophic exposure, and to have the flexibility of concierge medicine, there is a much cleaner way to do it.
Start with an ACA marketplace plan. Yes, premiums for a couple in their late 40s can run $20,000 to $30,000 per year at full cost. But what you get in return is no coverage cap and full legal protection as an insurance product. Your deductible can still be high, which keeps premiums lower. And being in your late 40s and in good health works in your favor.
Then, on top of that, add your concierge practice. You do not need to use the ACA plan’s network for routine care. You are paying the retainer for the concierge experience. The ACA plan exists for one reason: to protect you if something truly catastrophic happens and the bills climb past what any reasonable self-insurance strategy could absorb.
That combination, a straightforward high-deductible ACA plan plus a concierge practice, is the most common approach I see at this level of wealth. It is clean, it is simple, and it closes the coverage gap that a health sharing ministry with a million-dollar cap leaves behind.
Putting It All Together
The desire to have personalized medical care and a high-deductible structure makes complete sense at this level. The problem is not the philosophy. The problem is using a product with a coverage cap to handle a risk that, in the worst-case scenario, could easily exceed that cap by several multiples.
Concierge medicine is a quality-of-life decision. Catastrophic coverage is a financial protection decision. Keep them separate, structure each one properly, and you end up with a setup that actually does what you need it to do.
This post is adapted from a recent episode of the Scholar Wealth Podcast. For more perspective on health insurance strategies for high-net-worth families, listen to the full podcast episode here.