In-Office Dental Plans - Dental Membership Savings Plans or Direct Primary Care Agreements

Sep 22, 2026

In-office dental plan guidance explains how dental practices can offer membership savings plans or direct primary care agreements. It covers core pricing mechanics, such as fixed monthly or annual patient payments, free preventive services, and discounted non-preventive procedures. It also outlines key legal and contractual considerations, including state insurance treatment and “most favored nation” managed care impacts, and specifies documentation needs through patient agreements and clear service coverage terms. Implementation steps include calculating fixed fees, defining preventive services and frequencies, setting discount percentages, and establishing policy responses for missed benefits or refunds.

LanguageEnglish

CategoryLetters

FormatPDF

Pages11

Reading Time4 min

AccessFree to download

Step I: Legal Considerations

State insurance and licensing/registration questions

Managed care contracts and “most favored nation” clauses

Patient requirements and written agreement terms

Step II: Implementation

Set fixed annual patient payment

Define preventive services and coverage frequency

Choose discount percentages and establish plan policies

In-Office Dental Plans Dental Membership Savings Plans or Direct Primary Care Agreements Studies have shown that patients with a benefit plan are much more likely to seek dental care and accept treatment plans. When a practice is looking to grow without participating in a commercial dental plan, one option the office might consider is an in-office dental plan. These plans are also known as dental membership savings plans, or direct primary care agreement plans. While there are many variants, in general, the patient pays the doctor or dental office a fixed amount of money on a monthly or annual basis. Preventive services may be covered at no charge. Procedures other than preventive are then offered at a discounted fee. The plan design is up to the office, as is the cost to the patient for participating in the plan. When considering whether to implement such a plan, the office should consider whether revenue lost by discounting fees for existing cash patients will be offset by revenue gained through new patient acquisition or completion of treatment delayed for financial reasons. There are several commercial vendors who assist dental offices in establishing in-office plans for an administrative fee or portion of the production. The American Dental Association (ADA) Council on Dental Benefit Programs has developed this toolkit to help dental practices begin to evaluate an in-office option. The Council appreciates the input and will continue to update this resource as needed. Please send input to [dentalbenefits@ada.org](dentalbenefits@ada.org). Step I: Legal Considerations The ability of a dental office to set up an in-office plan depends on a variety of factors that include local and state laws, as well as existing contractual relationships between the dentist and third-party payers, especially those with a “most favored nation” clause. These factors are discussed further in the questions that follow. Consulting with your own attorney to determine how these factors affect your business decision is an important initial step. If necessary, your local bar association may be able to help you find an attorney knowledgeable in these areas. Some questions to consider before setting up an in-office dental plan include: Q. Does your state consider these types of plans to be insurance and, if so, would you have to license or register with the state accordingly? A. Your state may have its own rules that affect the establishment of an in-office dental plan. Laws vary from state to state. Appendix A is the list of states that have enacted direct primary care agreement legislation, which allows you to implement an in-office dental plan without having to register as an insurance company. Be sure to comply with any requirements. Q. How will any managed care contracts you have signed affect an in-office dental plan implemented by your office? For example, will the managed care plan invoke a “most favored nation” clause and require you to pass on those fees to its insured members? A. Your obligations under these contracts might present impediments to your establishing the plan, or to establishing it in the manner you wish. For example, when your contract with a third party payer contains a “most favored nation” clause it guarantees that the payer will receive the lowest rate that you charge for any procedure. This means that if your in-office plan fee for a procedure is less than the fee you have committed to with the payer, the payer is permitted to reimburse you at the lower fee. You will be accepting the lower fee for all patients covered by your in-office plan, plus all patients covered by the third-party payer’s plan. Also, the payer could conceivably attempt to go back to the establishment of your plan to seek partial reimbursement of the previously paid fees, or merely attempt to set that amount off against future payments to you. Q. What does the patient have to do to take advantage of this kind of plan?

FAQs

What are in-office dental membership savings plans and how do they work?

The patient pays a fixed amount monthly or annually. Preventive services may be covered at no charge, while other procedures are provided at a discounted fee based on the office’s plan design.

What legal factors should a dental office consider before implementing an in-office plan?

The office should review local and state laws and existing contracts with third-party payers, especially any “most favored nation” clause. Consulting an attorney familiar with these issues is emphasized as an initial step.

What should the patient agreement clearly describe?

The agreement should include covered and not-covered services, what is provided at each visit, coverage frequency, any additional fees, and restrictions such as refund limitations and consequences of missed appointments. Terms should also be clearly reflected in public advertisements or offers.

Sep 22, 2026

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