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Family and Pediatric Membership: Designing Care for the Whole Household
Adding a spouse is easy. Adding a newborn and a sixteen-year-old is a different practice. Children bring their own visit calendar and their own coverage rules, and as they grow they gain privacy rights of their own. This brief lays out what a concierge practice takes on when it opens membership to the household, and gives you a tool that turns your family mix into the design questions to settle before you set a price.
New in October 2026. Checked against the current AAP periodicity schedule, federal coverage rules and state consent summaries.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
A child is not a small adult member. The AAP and Bright Futures schedule calls for 11 well-child visits between the first week and 30 months, then one a year through age 21, and most health plans must already cover that preventive care in network with no copay. So a family membership has to add something the family is not already getting for free, and it has to price the extra physician time that infants and toddlers consume. Children make up nearly half of Medicaid and CHIP enrollment, and federal payment-in-full rules make fees for enrolled children a question for counsel. Teenagers can consent to some care on their own under state law, which changes how a household account works. Settle scope and privacy rules first. Price last.
Should a concierge practice offer family or pediatric memberships at all?
It depends on who will see the children and how much time they need. A practice built around one long annual adult visit takes on a very different workload with an infant in the household. Part 1 shows the calendar.
Go to the full answer ↓How many preventive visits does a child need?
The AAP and Bright Futures schedule lists 11 well-child visits from the first week through 30 months, then one a year from age 3 through 21.
Go to the full answer ↓Doesn’t insurance already cover well-child visits?
Usually, yes. Most plans must cover recommended preventive care for children with no copay or coinsurance when the provider is in network. Grandfathered plans are an exception.
Go to the full answer ↓Can we enroll children covered by Medicaid or CHIP?
Be careful. Federal rules require Medicaid providers to accept the program’s payment as payment in full, plus any allowed cost sharing. Whether and how that limits a membership fee is a question for counsel and your state Medicaid agency.
Go to the full answer ↓How should we handle a teenager’s privacy inside a family account?
Plan for it up front. HIPAA generally treats parents as a minor’s personal representative, with exceptions, and every state lets minors consent to STI testing and treatment. Part 4 covers the details.
Go to the full answer ↓What should we charge per child?
This brief does not recommend a price. The design tool in Part 5 estimates the preventive-visit load for a household and lists the questions to answer before you set one.
Go to the full answer ↓Children run on a different calendar
Most adult concierge memberships are organized around one long annual visit plus access in between. Pediatric preventive care is organized around development, and development moves fast in the first three years.
The national reference is the periodicity schedule published by the American Academy of Pediatrics and Bright Futures, which sets out the screenings and assessments recommended at each well-child visit from infancy through adolescence.1 Practice Insight The AAP’s own parent site turns it into a visit list: a first-week visit at 3 to 5 days, then visits at 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months, then one visit for each year of age from 3 through 21.2
A visit at 3 to 5 days old. For a membership practice this is the moment the family first tests the access promise, often in the middle of the night.2
Visits at 1, 2, 4, 6 and 9 months. Five visits in the first year after the newborn check.
Visits at 12, 15, 18, 24 and 30 months. The pace slows, but toddlers still need roughly two to three preventive visits a year.
One well visit a year. Some recommended screenings, such as hepatitis B risk assessment and HIV screening, run through age 21.1
Not a Bright Futures milestone, but a coverage one: young adults can generally stay on a parent’s health plan until 26.3 Policy and Law
Count the hours before you count the dollars. A household with a newborn generates six preventive visits in the first year, plus the fevers and feeding questions that fill much of infant care. A household with two teenagers generates two. A single family tier that treats those households the same will be priced wrong for one of them.
Much of a child’s preventive care is already paid for
The Affordable Care Act changed the arithmetic for pediatric memberships. Under section 2713 of the Public Health Service Act, most plans must cover preventive care for infants, children and adolescents based on guidelines HRSA supports, and HRSA works with the AAP on those guidelines through Bright Futures.4 For a family with an in-network pediatric provider, the well visit itself usually costs nothing at the door.5
That leaves a membership fee to pay for something else: time, access, continuity, a physician who answers the phone. Each rule below changes what that something else can be.
| Rule or program | What it says | Design question for a family membership | Evidence type |
|---|---|---|---|
| ACA preventive coverage | Plans generally cover children’s preventive services, including well-child visits and vaccines, with no copayment or coinsurance from an in-network provider.5 Grandfathered plans are exempt, and out-of-network preventive care generally is not covered without cost sharing.4 | Are you in network for the family’s plan? If you are not, the family may lose the free well visit by choosing you. | Policy and Law |
| Dependent coverage to 26 | Young adults can join or stay on a parent’s job-based plan until 26, even if they are married or living away from home. Marketplace rules and some state rules differ.3 | Where does a “child” end in your family tier: 18, 21 or 26? Matching the family’s insurance avoids surprises. | Policy and Law |
| Medicaid EPSDT | Medicaid covers comprehensive and preventive care for enrolled children under 21, with screening at intervals that meet reasonable standards of medical practice. States may adopt Bright Futures as that schedule.6 | Children in Medicaid already have a broad benefit. What would your membership add, and who would pay for it? | Policy and Law |
| Medicaid payment in full | State plans must limit participation to providers who accept the Medicaid payment as payment in full, plus any cost sharing the plan allows.7 | If you are a Medicaid provider, can you charge an enrolled child a membership fee at all? Ask counsel and your state Medicaid agency before enrolling any child in Medicaid or CHIP. | Policy and Law |
| Vaccines for Children (VFC) | VFC supplies vaccines at no cost for children 18 and under who are Medicaid-eligible, uninsured, underinsured or American Indian or Alaska Native. A VFC provider cannot charge for vaccine supplied by public sources, and must be a Medicaid provider to bill Medicaid for administering it.8 | Will you stock vaccines, enroll in VFC, buy private stock or send families elsewhere for shots? | Policy and Law |
| Commercial payer contracts | Network contracts can limit what an in-network physician may charge members. CMT Research Brief No. 43 covers the clauses to check. | Do your contracts treat a fee for a child differently from a fee for an adult? Read them before you launch. | See Brief No. 43 |
The free well visit is the reason many pediatric membership models sell access rather than checkups. Texas Children’s took a different route: its concierge program says well and sick visits with the concierge provider are covered by the membership fee and not billed to insurance, while diagnostic testing and vaccines are billed through insurance or self-pay.9 Either design can work. What matters is that the family understands what the fee replaces and what it does not. This is CMT’s editorial reading, not legal or billing advice.
A fee-based model reaches a minority of children
Public coverage is the norm in American childhood, not the exception. In June 2026, 35.0 million children were enrolled in Medicaid or CHIP, 47.9% of the programs’ 73.2 million enrollees.10 Population Data
Point-in-time counts understate how many families pass through those programs. A microsimulation study in JAMA estimated that most children enroll in Medicaid or CHIP at some point before 18, and that many go without insurance for a stretch, especially in states that did not expand Medicaid.11
Critics of concierge medicine will read those numbers as the core objection: a membership fee sorts patients by ability to pay, and children cannot choose their parents’ finances. The strongest research on adult conversions points the same way. A 2023 study in the Journal of Health Economics found that patients of physicians who converted to concierge practice used more care and that costs rose, without evidence the change extended lives.12 Population Data The AMA’s ethics guidance asks retainer practices to help patients who do not join find other care.13 Practice Insight For a pediatric conversion, those patients are families with children.
There is a workforce side too. A pediatric subspecialty workforce model funded by the American Board of Pediatrics Foundation found that subspecialist supply and training sites are poorly aligned with where children live: the child population is projected to grow 19% in the South and 23% in the West by 2040, against 4% in the Northeast, where supply is projected to be highest.14 Population Data A membership practice that coordinates referrals well may help its families find scarce specialists. It cannot add to the supply.
CMT does not favor one practice model over another. A family membership is a legitimate choice for families who want it and physicians who can deliver it. The honest case for it is continuity and access for the families inside the panel. The honest cost is that every child in a small panel is a child not in a large one. Practices converting an existing pediatric panel owe the families who stay behind a real transition plan; CMT Research Brief No. 32 sets one out for adult practices.
The teenager in the family account
A family membership usually has one account holder, one invoice and, often, one parent who books everything. Adolescents complicate that. They can consent to some care on their own in every state, and the rules on what parents may see vary from state to state. These are general points for a conversation with counsel, not legal advice.
The HIPAA Privacy Rule generally lets a parent see a minor child’s records as the child’s personal representative. There are exceptions, for example when the minor consents to care that the law does not require a parent to approve, or when the parent agrees to a confidential relationship between the minor and the provider. Even then, state or other law decides whether a parent may see those records; where it is silent, the licensed provider uses professional judgment.15
All 50 states and DC allow minors to consent to STI testing and treatment. Sixteen states let providers inform parents, or require it in some circumstances, and eight set a minimum age, as of August 2026.16
Twenty-three states and DC explicitly allow minors to consent to contraception; 16 more allow it under specific circumstances. Where no specific law exists, general consent rules apply.17
CMT’s reading: a teen who can consent to a service may reasonably expect the parent not to learn of it from a portal notification, a visit summary or an itemized invoice. Decide before enrollment who on the account sees what after a child turns 12 or 13, write it into the membership agreement, and explain it to parents at sign-up rather than in the middle of a conflict. Confirm the specifics with counsel in your state.
HIPAA’s parent-as-representative rule is about minors.15 Once a child is an adult, CMT’s reading is that the young adult should sign their own membership agreement and decide who sees their records, even while a parent pays and even while the young adult stays on the parent’s plan until 26.3
In a family membership the person who pays is often not the patient. The agreement has to say whom the practice answers to.
How others have built it, and how to design yours
Public examples are few, and most come from health systems rather than independent practices. Four data points show how differently the household question can be answered. All are company-reported or CMT poll data and are labeled Industry Research.
A pediatric membership that still bills insurance
Atrium Health Levine Children’s describes Perspective Pediatrics in Charlotte as membership-based primary care, “also known as concierge pediatric medicine,” with fewer patients per pediatrician and round-the-clock access to the care team. The annual fee is not covered by insurance; medical services are billed to insurance like any pediatric office, and copays may apply.18 Industry Research
Priced by the number of children
Texas Children’s Pediatrics says its concierge membership starts at $250 a month and that fees are based on the number of children enrolled, payable monthly or annually, with 30 days’ written notice to withdraw.9 Industry Research
An adult program with a teen tier
Inova 360 Concierge Medicine enrolls patients 13 and older. Its published fees are $2,400 a year for the first person, $2,200 for each additional adult and $1,200 for children of members aged 13 to 22, with panels capped at 400 patients.19 Industry Research
Few concierge pediatricians
In a CMT reader poll of 300 concierge physicians, pediatrics was 3% of the specialty mix, about nine physicians, while family medicine was 38%.20 The poll was open and self-selected, not representative; the margin of error at this sample size is about ±6 points. Industry Research Many children in concierge households are likely seen by family physicians, an inference CMT has not tested.
Insurers offer one more reference point. In KFF’s 2025 employer survey, the average family premium was $26,993 a year against $9,325 for single coverage, about 2.9 times as much (CMT calculation).21 Population Data Insurance pools risk; a membership sells time. The ratio is context, not a pricing rule.
These figures describe direct primary care (DPC), not concierge medicine. DPC usually operates outside insurance billing at lower monthly fees. They are shown here, separately, for context only and should not be read as concierge data.
Federal HSA rules for DPC arrangements set a separate monthly ceiling for family coverage. This is a tax rule for DPC, not a concierge benchmark.
CMT Research Brief No. 27 explains the rule and its limits.
Needed: the share of CMT-surveyed concierge practices that enroll children, the youngest age accepted, and whether household pricing is flat, per person, per child or tiered by age. Report concierge and DPC respondents separately, with sample size, dates and recruitment method.
Editor: replace this box with CMT survey results (with sample size, dates and recruitment method) before publishing, or delete it.
The tool below starts from your household mix and pediatric scope. It counts the preventive visits the AAP schedule implies and lists the questions to settle. It does not suggest a fee.
Family membership design check
Read the schedule
Walk through the AAP visit list with your own calendar and staffing in mind. Infants and toddlers change the workload more than any other member.
Write the household rules
Put age limits, teen privacy, who signs at 18 and how Medicaid-covered children are handled into the membership agreement, reviewed by counsel in your state.
Explain the trade
Tell families plainly what their insurance already covers and what the fee adds on top of it.
How this brief was built
CMT began with the AAP and Bright Futures periodicity schedule and the AAP’s parent-facing visit list, then checked federal coverage rules on HealthCare.gov, in a Congressional Research Service summary, on Medicaid.gov, in the eCFR and on the CDC’s Vaccines for Children pages. State consent rules for minors come from the Guttmacher Institute’s state policy summaries and the HHS HIPAA guidance on parents and minors. Coverage data come from CMS enrollment reports and a JAMA microsimulation study, read through Harvard’s news release. Program examples come from the public web pages of health systems that run concierge or membership programs and are labeled Industry Research. Every source was opened and confirmed in October 2026, except where the notes say otherwise.
Concierge and DPC were kept separate. The one DPC rule that bears on family pricing, the federal HSA limit for DPC arrangements, sits in a walled-off DPC box. The design tool computes preventive-visit counts directly from the AAP schedule; adult visit counts are an assumption the user can read as one annual visit per adult. It does not recommend fees and it is not legal, tax or clinical advice.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- How many concierge practices enroll children, and at what ages. No public dataset reports it, and CMT’s own specialty poll counts physicians, not household memberships.
- Whether family memberships change outcomes, retention or visit use for children. CMT found no study on concierge pediatrics specifically.
- How state Medicaid agencies treat a membership fee charged to a child who is enrolled in Medicaid or CHIP. CMT found no federal guidance written for that situation.
- How federal changes to Medicaid eligibility, which the JAMA authors flagged, will shift children’s coverage after 2026.
- How families actually split costs across members when a practice offers a flat household fee versus a per-person fee.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- American Academy of Pediatrics and Bright Futures. Periodicity Schedule (Recommendations for Preventive Pediatric Health Care), practice management page. Last updated February 6, 2025. www.aap.orgFunding: not stated (published by the American Academy of Pediatrics; Bright Futures is an AAP program supported by a cooperative agreement with HRSA, per CRS)
- American Academy of Pediatrics. Well-Child Care: A Check-Up for Success (visit schedule from the first week through age 21). HealthyChildren.org. Last updated March 17, 2026. www.healthychildren.orgFunding: not stated (published by the American Academy of Pediatrics)
- HealthCare.gov (Centers for Medicare & Medicaid Services). Health insurance coverage for children and young adults under 26. Accessed October 2026. www.healthcare.govFunding: federal (CMS consumer website)
- Forsberg VC. The ACA Preventive Services Coverage Requirement. Congressional Research Service, In Focus IF13010. May 23, 2025. www.congress.govFunding: federal (Congressional Research Service)
- HealthCare.gov (Centers for Medicare & Medicaid Services). Preventive care benefits for children. Accessed October 2026. www.healthcare.govFunding: federal (CMS consumer website)
- Medicaid.gov (Centers for Medicare & Medicaid Services). Early and Periodic Screening, Diagnostic, and Treatment. Accessed October 2026. www.medicaid.govFunding: federal (CMS)
- 42 CFR 447.15. Acceptance of State payment as payment in full. Electronic Code of Federal Regulations. Accessed October 2026. www.ecfr.govFunding: federal regulation
- Centers for Disease Control and Prevention. Vaccines for Children Program: program eligibility (for health care providers). Last updated August 27, 2026. www.cdc.govFunding: federal (CDC)
- Texas Children's Pediatrics. Concierge Medicine (program web page). Accessed October 2026. www.texaschildrens.orgFunding: industry (Texas Children's program web page)
- Medicaid.gov (Centers for Medicare & Medicaid Services). Medicaid and CHIP enrollment data: report highlights (June 2026 data, 50 states and DC). Accessed October 2026. medicaid.govFunding: federal (CMS)
- Harvard T.H. Chan School of Public Health. Majority of U.S. children enroll in Medicaid, many face coverage gaps by age 18 (news release on a microsimulation study by Shen Y, Sommers BD, Hatfield LA, Hayes C, Pandya A and Menzies N, published in JAMA September 24, 2025). Summary via Harvard Chan news release. hsph.harvard.eduFunding: not stated in the news release; author disclosures listed (one author reported foundation grants)
- Leive A, David G, Candon M. On resource allocation in health care: the case of concierge medicine. Journal of Health Economics. 2023;90:102776. doi:10.1016/j.jhealeco.2023.102776. ideas.repec.orgFunding: not stated
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- Cecil G. Sheps Center for Health Services Research, University of North Carolina. Forecasting future supply of pediatric subspecialties: addressing misalignment with population health needs (on the pediatric subspecialty workforce model published in Pediatrics, Vol. 153, Supplement 2, February 2024). April 11, 2024. www.shepscenter.unc.eduFunding: foundation (American Board of Pediatrics Foundation)
- U.S. Department of Health and Human Services, Office for Civil Rights. Does the HIPAA Privacy Rule allow parents the right to see their children's medical records? HIPAA FAQ 227. Content last reviewed December 28, 2022. www.hhs.govFunding: federal (HHS Office for Civil Rights)
- Guttmacher Institute. Minors' Access to STI Services (state policy summary, as of August 1, 2026). www.guttmacher.orgFunding: not stated (conducted and published by the Guttmacher Institute)
- Guttmacher Institute. Minors' Access to Contraceptive Services (state policy summary, as of August 1, 2026). www.guttmacher.orgFunding: not stated (conducted and published by the Guttmacher Institute)
- Atrium Health Levine Children's. Perspective Pediatrics: membership-based primary care (program web page). Accessed October 2026. atriumhealth.orgFunding: industry (Atrium Health program web page)
- Inova Health System. Inova 360 Concierge Medicine: program features and fees (program web page). Accessed October 2026. inova.orgFunding: industry (Inova program web page)
- Concierge Medicine Today, LLC. Physician reader poll of 300 concierge physicians: specialty (published on the CMT Media Desk, 2024). Open online poll; self-selected; not representative. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-conducted; no outside funder) CMT original
- KFF. 2025 Employer Health Benefits Survey: summary of findings. October 22, 2025. www.kff.orgFunding: not stated (conducted and published by KFF)
- Internal Revenue Service. Notice 2026-5: Expansion of health savings account availability and eligibility under the One, Big, Beautiful Bill Act. December 9, 2025. www.irs.govFunding: federal (Internal Revenue Service publication)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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