Healthcare

Healthcare spending for affluent households extends well beyond insurance premiums, and the gap between what insurance covers and what high-income families actually spend on health is substantial. Out-of-network specialists, elective procedures, executive health programs, concierge medicine practices, and international medical travel all sit outside the standard insurance model — and for many high earners, they represent a significant and growing line item.

Concierge medicine has become a meaningful expense category on its own. Direct primary care practices charge annual retainers of $1,500–$5,000 per adult in exchange for same-day appointments, longer visits, 24/7 physician access, and proactive health management that standard practices don’t offer. At flagship programs like MDVIP or private boutique practices in major cities, retainers can run $10,000–$30,000 per year per person. For a household of four fully enrolled in a top-tier program, annual retainer costs alone can reach $40,000–$60,000.

Executive health programs — comprehensive annual assessments that include advanced imaging, genetic screening, cognitive testing, and specialist consultations — run $3,000–$10,000 per person at programs like Cleveland Clinic Executive Health, Mayo Clinic Executive Health, or private programs in major cities. These are generally not covered by insurance and represent a cash-pay commitment for households that prioritize early detection and preventive care.

Mental health is another significant out-of-pocket category. Top-tier therapists and psychiatrists in major markets charge $300–$600 per session, rarely accept insurance, and for ongoing weekly therapy represent $15,000–$30,000 annually. For households with children, pediatric specialists, orthodontics, and behavioral health services add their own layer. The wellness dimension of health spending — trainers, functional medicine practitioners, recovery services — is covered in fitness & wellness. The full living cost picture lives in the Affluent Living pillar.