The health-care industry is witnessing a notable shift in dental care delivery models with in-house dental membership plans emerging as a significant practice builder. A continuous stream of surveys and research finds that affordability is a key factor in individual and family decisions to seek dental care.1-3 These studies highlight the growing need for cost-effective alternatives to traditional dental insurance, especially when people do not have access to employer-based dental insurance coverage.
The purpose of this article is to summarize a research report by Harmony Health,4 which includes a comprehensive evaluation of dental membership plans in the United States. The report delves into the costs, benefits, and overall impact of these plans on dental care accessibility and affordability. Through an in-depth analysis of more than 1,000 membership plans across all 50 states and Washington DC, the publication offers valuable insights into how these subscription-based models can serve both patients and dental practices.
One of the key findings from the report is the cost efficiency and comprehensive coverage offered by dental membership plans (table 1). The average monthly cost of these plans is $33.04 in nonrural areas and $29.23 in rural areas. Senior memberships (65 years and older) have the lowest average monthly cost at $21.92. These plans consistently cover preventive services such as cleanings, exams, and x-rays at no additional cost. Additionally, they offer substantial discounts averaging between 10% and 25% on procedures such as fillings, crowns, and orthodontics.
Diverse plan offerings are another highlight of the report. Dental membership plans cater to various demographics, with 34.7% of dental practices designing plans that incorporate structures for adults, children, and periodontal care. Family plans for a group of four cost an average of $80.84 per month, making them a cost-effective option for comprehensive family dental care. Financial benefits include significant discounts on procedures (figure 1). On average, membership plans provide discounts of 17.8% on endodontics, 18.6% on dentures, and 27.1% on sealants, significantly reducing out-of-pocket expenses for extensive dental work.
Comparing membership plans with traditional insurance
A comparison with traditional insurance shows that traditional dental insurance often has higher premiums and includes annual maximums that limit coverage but can be beneficial for low-risk patients wanting traditional preventive care as well as moderate-risk patients requiring occasional restorative services. For example, a patient with traditional insurance might pay a monthly premium of $50 and have an annual maximum benefit of $1,500. This setup can be advantageous for patients who require standard cleanings and occasional fillings, as these services are typically covered after a small deductible or co-payment.
In contrast, dental membership plans generally have lower monthly costs and do not impose annual maximums. This makes them particularly beneficial for patients who require extensive or elective care, such as veneers, implants, and clear aligners, which are often not covered by traditional insurance. For instance, a patient enrolled in a dental membership plan might pay $30 per month and receive comprehensive preventive care (cleanings, exams, x-rays) at no additional cost, along with significant discounts on more extensive procedures.
However, dental membership plans also have potential drawbacks. One limitation is that they may not cover as broad a range of services as traditional insurance. For instance, emergency dental care or specialist referrals might not be included in the membership plan, requiring patients to pay out-of-pocket for these services. Additionally, while membership plans offer significant discounts, they do not cover the full cost of treatments, which can still result in substantial expenses for patients undergoing major dental work.
In addition, traditional insurance often provides broader access to a network of dentists, whereas membership plans are typically limited to specific dental practices. This could limit patient choice and convenience, especially if the preferred dentist is not part of the membership plan network.
Recommendations for traditional insurance
To incorporate the benefits of membership plans, traditional dental insurance providers could adopt lower monthly premiums, enhance preventive care coverage, and eliminate or increase annual maximum limits. For example, offering tiered plans with varying coverage levels can make insurance more accessible. Providers could also cover more frequent cleanings and checkups at no extra cost and increase annual maximums to better support extensive dental work. Additionally, offering discounts on elective procedures such as veneers and implants can align insurance plans more closely with membership benefits.
Potential challenges include administrative complexity, cost management, and expanding provider networks. Investing in advanced software solutions and balancing lower-cost plans with high-deductible options can address these issues. Building partnerships with more dental practices and educating patients about new features will further support these changes.
Conclusion
The Harmony Health report sheds light on the significant potential of dental membership plans to revolutionize dental care delivery. By offering cost-effective and comprehensive coverage, these plans address key barriers to dental care accessibility and affordability. The findings highlight that membership plans can provide substantial savings on both preventive and extensive procedures, making them a viable alternative to traditional insurance.
For dental professionals, embracing the strengths of both traditional insurance and membership plans can enhance patient satisfaction and loyalty. By integrating the benefits of membership plans, such as lower costs and extensive preventive care, practices can offer more attractive options to their patients. This dual approach not only improves individual health outcomes but also contributes to reducing oral health disparities in underserved communities.
Editor's note: The article appeared in the September 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Vujicic M, Buchmueller T, Klein R. Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Affairs. 2016;35(12):2176-2182. doi:10.1377/hlthaff.2016.0800
- Gupta N, Vujicic M. Barriers to dental care are financial among adults of all income levels. Health Policy Institute Research Brief. American Dental Association. April 2019. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpibrief_0419_1.pdf
- Naavaal S, Griffin SO, Jones JA. Impact of making dental care affordable on quality of life in adults aged 45 years and older. J Aging Health. 2020;32(7-8):861-870. doi:10.1177/0898264319857967
- Smile by subscription: an evaluation of dental membership plans in the United States of America. Executive Summary. Harmony Health. https://cdn.oralgenome.com/images/Harmony/News-Updates/membership-plans-executive-summary.pdf
