About 72 million US adults, 27%, have no dental insurance, according to CareQuest Institute's State of Oral Health Equity in America survey of more than 9,000 adults in 2024. Medicare adds more: Medicare.gov says that in most cases it "doesn't cover dental services like routine cleanings, fillings, tooth extractions" or dentures. An in-office membership plan is built for them, and in an ADA Health Policy Institute poll of 874 owner dentists in July 2023, 26% offered one and 22% were considering it. Most of those plans share a problem: priced by guesswork, printed on a brochure, never mentioned on the phone. Here is how to price one from your own fee schedule, what to check with your state, and what the phone should say.
What a membership plan is, and what it is not
The ADA's description: the patient "pays the doctor or dental office a fixed amount of money on a monthly or annual basis" and in return "generally receives preventive services at no charge, with other procedures offered at a discounted fee." It is not insurance. There are no claims, no deductible, no annual maximum and no third party: it is an agreement between one practice and one patient.
Price it from your own fee schedule
1. Add up the preventive bundle at your full fees
The usual adult bundle is two exams, two cleanings and one set of bitewing x-rays a year. Take the fees from your own schedule. For illustration only: at $95 an exam, $120 a cleaning and $75 for bitewings, the bundle is $505.
2. Set the yearly fee between two anchors
The ceiling is the bundle at full fee: a member has to save on preventive care alone, or the plan fails the first question a caller asks. The floor is what your lowest-paying PPO would have paid you for the same visits; price below that and the plan pays you less than the contract does. Pick a point between them. In the example, $420 a year, or $35 a month, saves the member $85 before any treatment.
Then check it against the market. Harmony Health's analysis of more than 1,000 membership plans in all 50 states, summarised in Dental Economics in September 2024, found an average monthly cost of $33.04 outside rural areas and $29.23 in rural ones, $21.92 for senior plans, and $80.84 for a family of four. Use those as a check, not a target; your fees set your price.
3. Choose one discount for everything else
The same analysis found discounts averaging between 10% and 25% on procedures such as fillings and crowns. One number is easier to say on the phone than a schedule. Test it against your PPO contracts first: the Washington State Dental Association warns that some carry a "most favored nation" clause, which "prohibits offering a discount greater than the PPO."
4. Put the terms on one page
Who can join (patients without dental insurance), the twelve months it runs from the joining date, what is included, the discount, what is excluded, that unused visits expire, and how to cancel. The ADA's toolkit includes a spreadsheet calculator "to help predict the financial impact"; run your numbers through it before you print anything.
Check your state before you take a dollar
None of this is legal advice. Taking money now for care delivered later is what insurance regulators exist to watch, and states disagree about where a membership plan falls. ADA News reported in 2018, citing the Consumer Health Alliance, that 34 states had discount health program laws and 23 of them required a licence or registration, in-house dental plans included, and that some states "may consider these types of plans to be a form of prepaid insurance." Three states show the spread:
- Illinois has a statute for it. The In-Office Membership Care Act says agreements that meet its terms "are not subject to regulation as insurance." The terms: a written contract, the patient's right to end it at will by written notice, a prescribed disclaimer that it is not health insurance, no bill sent to an insurer for the plan's services, and no sale to employers or groups.
- Washington goes the other way. The state dental association reports that the insurance commissioner's office "has strongly prohibited any pre-payment format" and any "pay-for-your-discount format"; the model it cleared instead is a voucher handed over after a visit, expiring in twelve months.
- California sits between. The California Dental Association says the Department of Managed Health Care has authority over discount health plans and that a practice setting one up "should have the plan's design reviewed by the department." An advertised discount must also show the non-discounted fee, the discounted fee or percentage, and how long it runs.
So: read the state-by-state list in the ADA toolkit, call your state dental association, and have an attorney read the agreement. Monthly billing also makes the plan a subscription under state auto-renewal laws; our memberships and specials guide covers what those require.
How the phone should sell it
A membership plan is sold in one sentence, on the call, at the moment the caller says she has no insurance. The signed agreement happens at the desk; the phone's job is the sentence and a booked exam. Write yours first: "$35 a month covers your two cleanings, exams and x-rays for the year, and takes 15% off anything else." If the desk can't say it in a breath, shorten the plan, not the sentence.
"I don't have insurance."
"That's fine, a lot of our patients don't. A new-patient exam with x-rays is $[fee]. Most patients without insurance join our membership plan: $[amount] a month covers your two cleanings, exams and x-rays for the year, and takes [X]% off anything else. You can decide at your visit. I have Tuesday at 8:10 or Thursday at 2:30; which is better?"
"I'm on Medicare."
Ask which kind before answering; some Medicare Advantage plans include dental benefits and Original Medicare, in most cases, does not.
"Is that Original Medicare, or a Medicare Advantage plan with dental? [Original:] Original Medicare doesn't pay for routine dental care, so most of our patients on it use our membership plan: $[amount] a month for your cleanings, exams and x-rays, and [X]% off other treatment. Shall I book your first visit?"
"How much is a cleaning?"
"A cleaning is $[fee], and the exam with it is $[fee]. On our membership plan both are included, twice a year, for $[amount] a month. Do you have dental insurance, or would the plan be useful?"
Two prices, side by side, then the insurance question. Our insurance scripts cover the caller whose plan you don't accept.
"Is this insurance?"
"No, and that's the point. It's an agreement with our practice only: no claims, no deductible, no yearly maximum. It runs for twelve months from the day you join, it's for patients without dental insurance, and it's only good here."
Three rules for whoever answers. Never call it insurance, coverage or a policy. Never quote savings on treatment nobody has diagnosed: "15% off whatever the dentist recommends" is true; "you'll save $300 on that crown" is a guess. And book first: the caller who books an exam can join at check-in; the caller who is "sent some information" is gone. The plan belongs after the insurance question in your new-patient phone script.
The same sentence at 7 pm
Give whatever answers after hours, a live service or an AI receptionist, the one-page terms and your fee sheet, then run the after-hours call test: say you have no insurance and ask what a cleaning costs. You should hear both prices, the sentence, and two appointment times. ClinicEcho's receptionist does that from the terms you approve, for $497 a month with a 14-day free trial, and we sign a BAA before it takes a call.
Four numbers to watch
Each month, from your own records: new-patient callers without insurance, how many heard the plan, how many joined, and how many members renewed at twelve months. Callers who never hear it are a phone problem; callers who hear it and don't join are a price or a sentence problem; members who don't renew are a recall problem. Our cost per booked patient guide shows how to report the first two.
Hear what your patients would hear
ClinicEcho's AI receptionist is answering a demo dental practice right now. Call it, ask about an appointment, try to book. Then request a free audit and we'll call your own clinic after hours and show you what happens.
Frequently asked questions
How much should a dental membership plan cost?
Price it from your own fee schedule: add up two exams, two cleanings and a set of bitewing x-rays at full fee, then set the yearly fee below that total and above what your lowest-paying PPO would pay for the same visits. As a check, an analysis of more than 1,000 US plans found an average of $33.04 a month outside rural areas and $29.23 in rural ones.
Is an in-office dental membership plan legal in my state?
It depends on the state. Illinois has a statute saying a compliant plan is not insurance; Washington's insurance regulator has objected to prepaid and pay-for-a-discount formats; California's managed-care department asks to review the design. Check the ADA toolkit's state list, ask your state dental association, and have an attorney read the agreement before you sell one.
Can patients with dental insurance join?
Most practices limit the plan to patients without dental benefits. The plan is not a way to discount a co-pay, Illinois bars billing an insurer for services delivered under the agreement, and some PPO contracts restrict discounts deeper than the contracted fee. Keep it to uninsured patients unless your attorney says otherwise.
Can an AI receptionist explain the plan to callers?
Yes, from the one-page terms you approve: who can join, the fee, what is included, the discount and what it is not. ClinicEcho quotes the regular and member price side by side, books the exam and sends a transcript within a minute, for $497 a month with a 14-day free trial, under a BAA signed first. Call the demo line, (602) 536-0014.
Sources
- CareQuest Institute for Oral Health, "New Report: 72 Million Adults in the US Lack Dental Insurance" (May 2025; State of Oral Health Equity in America survey, March to May 2024, more than 9,000 adults)
- Medicare.gov, "Dental services"
- Becker's Dental Review, "More than 25% of practices offer in-office dental plans" (Aug 1, 2023; ADA Health Policy Institute poll of 874 owner dentists)
- American Dental Association, "Is an in-office dental plan right for your practice?" (definition; toolkit with calculator and state list)
- Dental Economics, Sean Boynes and Kelli Bingham, "Smile by subscription: An evaluation of dental membership plans in the US" (Sept 6, 2024; summarises a Harmony Health report, with which both authors are affiliated)
- ADA News, "In-office membership plans could generate patient loyalty, revenue" (July 9, 2018; state discount-program laws per the Consumer Health Alliance)
- Illinois Public Act 101-0190, In-Office Membership Care Act
- Washington State Dental Association, "Dental Wellness Plans" and "Wellness Plans & WA Law: What to Know" (July 25, 2018)
- California Dental Association, "Offering a discount dental plan in the practice: the basics" (July 29, 2020)