The dental landscape is changing, and it is changing fast. Across the country, practices are re-evaluating their contracts with PPO insurance plans, and more than ever, they’re choosing to reduce or completely eliminate their dependence on insurance networks due to lack of fair reimbursements. In their place, a highly effective alternative is rising…In-House Membership Plans.
These plans provide patients with affordable access to care while giving practices the stability, freedom, and profitability they’ve been missing for years with in-network insurance fees. And as economic pressures, declining reimbursements, and increasing administrative requirements continue to grow, membership plans have gone from a “nice option” to a must-have strategy for long-term practice success.
Why Practices Are Dropping PPO’s
Declining Reimbursements Are No Longer Sustainable
Every year, reimbursements shrink while overhead rises. Payroll, supplies, lab fees, and technology investments continue to increase, yet most PPO’s haven’t adjusted their fee schedules to match the economic reality. Even after negotiating higher reimbursement rates, offices simply cannot meet the financial bottom line to offset cost of operations.
The result of this is that doctors work harder, faster, and longer, while net revenue continues to drop. Membership plans allow practices to reclaim control of their profitability.
Administrative Burden Is Higher Than Ever
The administrative tasks of insurance verification, pre-authorizations, denied claims, long wait times on the phone, resubmissions, attachments, narratives and appeals drain time in the day and overwhelm front-office teams who are already stretched thin.
Membership plans eliminate claims processing, insurance calls, EOB headaches and coverage confusion. This frees the team to focus on patient care rather than administrative chaos.
PPO’s Control Treatment, Not Clinicians
When dentistry is dictated by what insurance will or will not cover, the quality of care suffers! Membership plans put decision-making back where it belongs…between the provider and the patient, not a third-party insurance company!
How Membership Plans Increase Case Acceptance and Loyalty
They Make Dentistry Predictable and Affordable
Patients want to know what their dental care will cost, what’s included, and how to budget for treatment.
Membership plans offer a clear, predictable structure for this. One annual (or monthly) fee, no deductibles, no waiting periods, no maximums, no exclusions, and no “insurance won’t cover it” conversations.
When patients understand their coverage, they say yes more often and without hesitation.
They Remove the Fear of Unexpected Costs
Much of the resistance to dentistry comes from fear of what the bill might be. Membership plans allow patients to feel in control of their care and more comfortable committing to treatment. When patients feel safe financially, they are far more likely to prioritize their oral health.
Patients Feel Loyal to the Practice, not the Insurance Company
Insurance-driven patients are loyal to the insurance network. It is as simple as that. Membership-driven patients are loyal to you! This creates higher retention, more consistent hygiene schedules, stronger relationships, greater trust (this is HUGE), and more referrals from patients.
When patients invest in your plan, they invest in your practice!
Membership Plans Increase Treatment Acceptance
When patients receive 10–20% off restorative, implant, cosmetic, or specialty care, they feel empowered to move forward with treatment.
The thought process is simple.
- Discounts increase perceived value.
- Predictability reduces stress.
- Trust boosts confidence.
- Relationships increase motivation.
- It becomes easier for patients to say:
“Yes, let’s go ahead and schedule that.”
What to Include in a Successful In-House Membership Plan
A successful plan is simple, structured, profitable, and easy to understand. Here’s what you should include:
A Preventive Plan (Standard Adult & Child Preventive Care)
This should cover the basics:
✔ 2 cleanings per year
✔ 2 exams per year
✔ Annual X-rays
✔ Fluoride (if desired)
✔ 10–20% off additional treatment
This is your foundation…your “entry-level” plan for healthy patients.
A Periodontal Plan (For Patients With Gum Disease)
These patients often feel financially overwhelmed by the number of visits they need. A perio plan ensures they maintain their health and stay consistent.
A perio plan should include:
✔ 3–4 periodontal maintenance visits
✔ 2 doctor exams
✔ Annual X-rays
✔ Irrigation (optional)
✔ 10–20% off all treatments
✔ Option for localized therapy discounts
This is one of the most valuable plans in a practice!
An Implant Maintenance Plan
As implant dentistry continues to grow, so does the need for structured implant follow-up.
Include services such as:
✔ 3-month implant maintenance cleanings
✔ Prosthesis removal and cleaning
✔ Annual screw replacement
✔ Annual locator/attachment replacement
✔ Radiographs
✔ Peri-implant probing
✔ Inspection of implants, prosthesis, and attachments
✔ Replacement of O-rings, clips, or inserts
✔ 20% off restorative/implant services
Patients with implants appreciate structured, predictable maintenance and it protects the doctor’s work.
In-house membership plans are no longer a trend or limited to just a few practices. They’re a strategic movement in dentistry. They give practices the freedom to provide higher-quality care, reduce administrative stress, and build financial stability without relying on minimal insurance reimbursements.
For patients, membership plans offer clarity, affordability, and a sense of belonging. For practices, they offer control, profitability, and loyalty.
This is the direction dentistry is moving, and practices that embrace membership plans now will be the practices that grow stronger, faster, and more independently in the years ahead.
Sherri Merritt
Dental Consultant & Trainer
