--- title: "How dental membership plans work for practices and patients" description: "A dental membership plan is an in-office plan with a set fee for patients. See how the ADA describes it, the legal checks to run, and how to model the cost." url: https://joncopeland.multisites.ai/blog/dental-membership-plans publisher: Copeland Consulting Services email: drcopeland@joncopelanddds.com contact: https://joncopeland.multisites.ai/contact --- # How dental membership plans work for practices and patients A dental membership plan, also called an in-office plan, has patients pay a fixed amount monthly or yearly. In return they generally get preventive care at no charge and discounts on other work. The ADA offers a toolkit for evaluating it, and state rules vary, so involve an attorney. Growth and patientsPublished October 26, 20264 min read A dental membership plan is a plan that a practice offers directly to patients who do not have dental insurance, or who do not use it there. The patient pays the office a set amount, and the office gives defined services in return. This post explains the model with ADA sources and lists the checks to run before launch. It is general education, not legal or tax advice. ## What is a dental membership plan? The ADA calls it an in-office dental plan, “sometimes called a dental membership savings plan or direct primary care agreement.” The ADA explains the structure: “Under such a plan, the patient pays the doctor or dental office a fixed amount of money on a monthly or annual basis. In return, the patient generally receives preventive services at no charge, with other procedures offered at a discounted fee.” The glossary entry on the [in-house membership plan](https://joncopeland.multisites.ai/glossary/in-house-membership-plan) gives the short definition. The plan is a contract between the practice and the patient, not a contract with a carrier. That is why state rules matter, as shown below. ## Why do practices consider these plans? The ADA frames it as an option for a practice that does not join commercial plans. It says “research shows that patients who have a benefit plan are more likely to seek dental care and accept treatment plans,” and that for “a growing practice that does not participate in a commercial dental plan,” an in-office plan “may be a viable option to improve patient engagement and retention.” That statement is a possibility, not a promise. Results depend on the practice, the patients and the plan design. Treat any number you hear about growth from a plan with caution unless it comes with a named source and year. A practice that is [out-of-network](https://joncopeland.multisites.ai/glossary/out-of-network) with many carriers, or that has patients with no [dental benefits](https://joncopeland.multisites.ai/glossary/dental-benefits), is the typical fit. The [out-of-network dental practice](https://joncopeland.multisites.ai/blog/out-of-network-dental-practice) post covers the network side. ## How does a plan compare with insurance? Feature In-office membership plan Dental insurance plan Who the patient pays The practice, at a fixed monthly or annual amount A carrier or employer, through premiums What is included Defined by the practice, generally preventive care plus discounts Defined by the plan contract Who sets fees The practice The carrier, for in-network dentists Claims Usually none Claims and an [explanation of benefits](https://joncopeland.multisites.ai/glossary/explanation-of-benefits) Rules to check State laws on these agreements Contract terms and state insurance rules The first column describes what the ADA page says about the model. The practice chooses the exact terms, so two plans can look different. ## What should a practice check before launch? The ADA says the Council on Dental Benefit Programs “has developed a toolkit to help dental practices evaluate whether an in-office dental plan option is right for them.” The toolkit “contains a document that addresses common legal considerations and implementation steps, and includes checklists, a list of regulations by state, and a sample letter to introduce the program to patients.” Steps a practice can take: 1. Read the ADA toolkit and its state regulations list. 2. Check your state’s rules on direct primary care agreements. The ADA insurance page links a status page for this. 3. Ask an attorney how the plan should be worded, whether it must be registered, and how to word marketing. 4. Check any [PPO participation](https://joncopeland.multisites.ai/glossary/ppo-participation) contracts you hold. Some contracts address discounts and how the practice treats its other patients. 5. Ask a CPA how to record the payments and handle taxes. 6. Review the ethics rules on fees. The ADA Code of Ethics says “it is unethical for a dentist to increase a fee to a patient solely because the patient is covered under a dental benefits plan.” Your plan fee and your regular [fee schedule](https://joncopeland.multisites.ai/glossary/fee-schedule) should line up in a way that you can explain. ## How can a practice model the cost? The ADA toolkit “contains a calculator in Excel spreadsheet format to help predict the financial impact of adopting an in-office dental plan.” Use it, or build your own, with these inputs: - The membership fee and the number of members you expect. - The services included at no charge and the time each one takes. - The discount on other procedures and how often members use them. - The cost of billing, software and any outside vendor. - The change in schedule load, since included visits take chair time. Run a low, middle and high case, and write down your assumptions. Do not copy a member count or a revenue gain from an article or a vendor page without a named source and year. ## What about vendors? The ADA notes that for offices that “wish to hire an outside vendor for assistance in creating an in-office dental membership plan,” it provides a link to an ADA endorsed option. An endorsement from the ADA is not a fit check for your practice. Ask each vendor for its fees, contract length and exit terms, and have an attorney read the agreement. ## How should a practice present the plan to patients? Keep the wording plain and factual. State what is included, what it costs, what is not covered and how to cancel. Avoid pressure language, promises of savings and the word “insurance” if the plan is not insurance. The ADA toolkit includes a sample patient letter that you can adapt. Have your attorney review all patient-facing wording, including the website, as part of the state rules check. ## Next step Plans like this sit inside wider growth planning, covered in the [grow a dental practice guide](https://joncopeland.multisites.ai/guides/grow-a-dental-practice), and they connect to the choices in the [PPO participation decision guide](https://joncopeland.multisites.ai/guides/ppo-participation-decision). To discuss practice finance topics with Dr. Jon Copeland, DDS, a general dentist in Wildwood, Missouri, [contact Dr. Copeland about consulting](https://joncopeland.multisites.ai/contact?topic=consulting). ## Frequently asked questions ### Is a dental membership plan insurance? The ADA describes it as a modern alternative to dental insurance in which the patient pays the practice directly. State laws differ on how these plans are treated, and the ADA tells practices to check state rules before setting one up. Ask an attorney. ### What do patients usually get from the plan? The ADA says the patient generally receives preventive services at no charge, with other procedures offered at a discounted fee, in return for a fixed monthly or annual payment. ### How can a practice check whether a plan makes sense? The ADA Council on Dental Benefit Programs publishes a toolkit with a legal considerations document, checklists, a list of state regulations, a sample patient letter and a spreadsheet calculator for the financial impact. ## Terms on this page - [In-house membership plan](https://joncopeland.multisites.ai/glossary/in-house-membership-plan) - [Explanation of benefits](https://joncopeland.multisites.ai/glossary/explanation-of-benefits) - [PPO participation](https://joncopeland.multisites.ai/glossary/ppo-participation) - [Dental benefits](https://joncopeland.multisites.ai/glossary/dental-benefits) - [Code of ethics](https://joncopeland.multisites.ai/glossary/code-of-ethics) - [Out-of-network](https://joncopeland.multisites.ai/glossary/out-of-network) - [Fee schedule](https://joncopeland.multisites.ai/glossary/fee-schedule) - [In-network](https://joncopeland.multisites.ai/glossary/in-network) - [ADA](https://joncopeland.multisites.ai/glossary/ada) ## Sources 1. [ADA: Is an in-office dental plan right for your practice?](https://www.ada.org/resources/practice/dental-insurance/is-an-in-office-dental-plan-right-for-your-practice) 2. [ADA: Is an in-office dental plan right for your practice? (toolkit)](https://www.ada.org/resources/practice/dental-insurance/is-an-in-office-dental-plan-right-for-your-practice) 3. [ADA: Dental Insurance](https://www.ada.org/resources/practice/dental-insurance) 4. [ADA: Code of Ethics, Veracity (5.B.2 Overbilling)](https://www.ada.org/about/principles/code-of-ethics/veracity) Written by Copeland Consulting Services and checked against the sources above on October 26, 2026. Rules, data and guidance change, so check the linked page before you act on it. ## Keep reading - [How to grow a dental practice: a systems guide with sourcesPractice growth comes from a small set of measurable systems: new patient flow, patient retention, schedule use, payer mix and overhead. Published data shows national demand is limited, so most practices grow by keeping patients, filling the schedule and reading their own numbers monthly. This guide lists each lever, how to measure it and what sources say.](https://joncopeland.multisites.ai/guides/grow-a-dental-practice) - [Out-of-Network dental practice: what it means for patientsAn out-of-network dental practice does not hold a participating agreement with a patient's dental plan. In a PPO the patient may pay more but still get a benefit. In an EPO the plan pays no benefit. Practices should explain this to patients and check billing rules with an attorney.](https://joncopeland.multisites.ai/blog/out-of-network-dental-practice) - [The PPO participation decision: data to pull, contract terms and questions to askA dental PPO contract trades a lower fee schedule for network status with a plan. The choice belongs to the practice owner, with an attorney and CPA. This guide gives no advice on joining or leaving. It lists how PPOs work, the data to pull by payer, the contract terms to read and the questions to ask.](https://joncopeland.multisites.ai/guides/ppo-participation-decision) - [Starting a dental practice: planning, funding and complianceStarting a dental practice means building the business from nothing: a plan, a startup cost list, funding from a lender, a licensed entity, a site, equipment, a team and compliance systems. The SBA publishes free planning tools. Cost depends on your plan, so get quotes. This guide is education, not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/starting-a-dental-practice) - [Buying a dental practice: steps, financing and due diligenceBuying a dental practice usually runs in six stages: define your goals, get financing, value the practice, sign a letter of intent, complete due diligence, and close. Lenders, attorneys and accountants each own part of the work. This guide explains the steps and lists questions to ask. It is not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/buying-a-dental-practice) - [Dental case acceptance: what the research, the ADA Code and vendors sayCase acceptance is the share of presented treatment plans that patients schedule or complete. Research on patient decisions points to cost, fear and communication. The ADA Code requires dentists to inform patients of proposed treatment and reasonable alternatives. A higher rate is not an ethical goal by itself, and vendor benchmarks use different formulas.](https://joncopeland.multisites.ai/guides/dental-case-acceptance-guide) ## Talk with Dr. Copeland [Contact Dr. Copeland](https://joncopeland.multisites.ai/contact)[Email](mailto:drcopeland@joncopelanddds.com)