The quiet part about old money wellness spending is that nobody talks about it. Not at dinner parties. Not in interviews. Certainly not on Instagram. The whole aesthetic depends on looking like you woke up this way, that your skin, your posture, and your energy are simply genetic gifts rather than the product of a six-figure annual maintenance budget. Let’s decode what it actually costs.
The Annual Baseline: What Wealthy Americans Spend
Americans spend an average of $5,321 per year on wellness, according to the Global Wellness Institute. That figure places the U.S. fifth globally, behind the Seychelles, Switzerland, Iceland, and Aruba. However, that average obscures a vast chasm between what a typical consumer spends and what the top 1% invests in their health.
For affluent households earning $500,000-plus annually, wellness spending often exceeds $100,000 per year when you account for concierge medicine, private training, aesthetic treatments, supplements, nutrition coaching, and wellness travel. This isn’t vanity. It’s infrastructure. And the returns, measured in energy, appearance, and longevity, compound in ways that reinforce every other advantage wealth provides.
Concierge Medicine: $4,000 to $80,000 Per Year
Concierge medicine fees range from $1,200 to $100,000 annually, depending on the tier. Standard practices like MDVIP charge roughly $1,700 per year for extended appointments and same-day access. Mid-tier practices run $4,000 to $10,000. And ultra-premium firms like Private Medical, founded by Dr. Jordan Shlain, charge $40,000 per adult and $25,000 per child for what he describes as “a family office for your health.”
Private Medical serves over 1,000 wealthy families through a team of 135 physicians, nurses, and clinical staff providing 24/7 on-call service. Shlain has cultivated relationships with over 4,000 specialists, enabling immediate connections to the right expert for any condition. As he told CNBC, “I’m 70% doctor, 15% psychologist, 10% rabbi, and 1% friend.”
The concierge medicine market reached nearly $7 billion in 2023 and is projected to grow by more than 50% by 2032, reaching $11 billion annually. More than 20% of Americans in the top 1% of income earners already pay extra fees for direct doctor access.
Aesthetic Maintenance: $12,000 to $50,000 Per Year
The old money face doesn’t happen naturally after 40. It happens at the medspa. A typical maintenance schedule for an affluent East End woman includes Botox every three to four months ($1,500-$2,500 per session), dermal fillers twice yearly ($2,000-$5,000 per session), monthly facials ($300-$600), and quarterly body treatments ($500-$2,000).
At the premium tier, add Dr. Barbara Sturm-level skincare products ($3,000-$8,000 annually), annual LED and laser treatments ($2,000-$5,000), and PRP therapy ($1,000-$3,000 per session). The Hamptons medspa circuit adds seasonal premiums during summer months when concierge practitioners charge top dollar for house calls.
Private Fitness: $15,000 to $60,000 Per Year
A personal trainer in Manhattan or the Hamptons charges $150 to $500 per session. At three to five sessions per week, that’s $23,000 to $130,000 annually. Most affluent clients land somewhere in the $30,000 to $60,000 range, supplemented by boutique studio memberships.
Premium fitness memberships add another layer. Tracy Anderson’s studios charge $900 to $1,500 per month. Equinox runs $200 to $500 per month depending on location. Pilates studios, yoga memberships, and cycling classes layer on additional costs. The truly committed maintain memberships at multiple studios to avoid monotony.
Nutrition and Supplements: $5,000 to $20,000 Per Year
Private nutritionists charge $200 to $500 per session, with most affluent clients booking monthly or biweekly consultations. Meal delivery services designed for high-net-worth households run $1,000 to $3,000 per month. Supplement stacks from premium brands add $200 to $500 monthly.
Moreover, the rise of functional medicine has introduced expensive diagnostic testing into the wellness routine. Comprehensive blood panels, food sensitivity tests, gut microbiome analysis, and hormone panels can run $3,000 to $10,000 annually when ordered through integrative medicine practitioners rather than standard physicians.
Wellness Travel: $10,000 to $100,000 Per Year
Annual wellness retreats have become a fixture of the old money calendar. A week at Clinique La Prairie in Switzerland runs $10,000 to $40,000. SHA Wellness Clinic in Spain commands similar rates. Canyon Ranch, Miraval, and Golden Door serve as domestic alternatives at $3,000 to $10,000 per week. Many affluent families budget for two to four wellness trips annually.
The Total: $50,000 to $300,000 Per Year
When you add concierge medicine, aesthetic maintenance, private fitness, nutrition, supplements, and wellness travel, the annual cost of looking like old money ranges from $50,000 at the entry level to $300,000 or more at the ultra-premium tier. That’s a house payment in most zip codes. In Southampton, it’s a rounding error.
The irony is profound. The old money aesthetic is supposed to signal effortless natural beauty. In reality, it signals a maintenance budget that rivals a small business’s operating expenses. But that’s the point. The effort is invisible. The result looks genetic. And the people who can afford it never discuss the price.
For more on the industries profiting from this spending, explore our medspa industry analysis and the dermatologist-to-brand pipeline reshaping luxury beauty.