When Maya Mackrandilal opened up an email from her primary care physician in 2021, she laughed. She had recently switched to the practice, and the letter informed her that, starting in just a few months, it would institute a fee of $250 per year, in addition to whatever she paid for insurance. Her husband also saw that doctor, so as a family, it would cost them $500 more each year. 

“I thought, ‘There is no way I am paying this money,’” she said. 

Mackrandilal decided to find a new physician in Los Angeles who didn’t charge a fee, an arduous process that she ultimately decided was worth it, because she said she likes her new physician better. Still, the experience made her wary and on edge, waiting for the next fee to drop. Her child’s pediatrician doesn’t charge one yet, but she’s heard many do, and she said they’d change doctors if it happened. 

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These annual fees are becoming more common among health care providers in California’s major metros. There isn’t a standard for what these fees cover, let alone what they cost, creating a new “wild west” that many patients don’t even realize exists until after they’ve scheduled an appointment. For some, a few hundred dollars every year may be a nominal amount to pay for access to quality health care, but for others, it’s widening the disparity in an already fragmented and costly medical system. 

Reinventing the system

Hybrid primary care — the combination of traditional insurance-based billing and a membership fee — has been around for nearly two decades. When it debuted, an emphasis on a high-touch, tech-focused approach to preventive medicine seemed revolutionary, for those who could afford it. Gone were the days of struggling to get in to see a doctor when an ailment arrived; instead, members could get a same-day appointment, often using digital technology in a new way. 

Don't let Google decide who you trust.

The most well-known pioneer in the space, San Francisco-founded One Medical, opened up in 2007. Membership started at $100 a year and often came fully covered by big tech companies, helping supercharge its rapid expansion. Ultimately, Amazon acquired One Medical in 2023. Today, it has around 240 offices across the U.S. and more than 800,000 members, as of 2022.  

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FILE: Street-level view of a One Medical facility in the Mission District of San Francisco on Sept. 11, 2025.

Since then, many copycats have emerged, especially in California, including biometrics-focused Forward and women’s health-focused companies like Tia. But now, more traditional practices are adopting the model, instituting their own annual fees, frequently stating they need them to stay afloat. Doctors cite a number of reasons for why this additional revenue is necessary, most often noting increasingly low insurance reimbursements, the need for more administrative staff to run a practice and overall physician burnout. 

And it’s not just hybrid........

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