In-office membership plans: doing the arithmetic yourself

More practices now sell a membership of their own: a yearly fee, some visits included, a percentage off other treatment. It is offered as an alternative to insurance for people who do not have any, and it is not insurance in any respect.

Nothing is underwritten. No claim is filed. There is no annual maximum and no reimbursement. It is an agreement with one practice about what that practice will charge you, and it is worth exactly what that arithmetic comes to for your teeth.

What is usually in one

The common shape is two check-up examinations, a set of x-rays, and two cleanings a year, plus a stated percentage off other treatment at that practice. Some include emergency exams; some exclude specialist work entirely.

Prices and contents differ practice by practice and none of them is published anywhere central, so this site prints no membership fee and no discount percentage for any plan. Anybody quoting you a national figure for these has invented it.

The sum

Three lines, and you can do it on the back of the estimate you were given. Write down the membership fee for a year. Write down what that practice charges for the routine care the membership includes, at its own fee, for a year. Then write down what the percentage discount would save you on the treatment you actually need.

If lines two and three together are larger than line one, the membership pays. If they are not, it does not, and no amount of framing changes that. The trap is line two: a membership that includes two cleanings is competing with two cleanings, not with an imaginary year of disaster.

Every input is a number the practice can give you in writing. If any of the three cannot be produced on paper, that is an answer about the plan rather than a gap in your research.

The ruler to judge line two against

You will not know whether the practice's own fee for a cleaning is ordinary unless you have something to compare it with. On three published payer schedules an adult cleaning is worth $60.94, $73.87 and $81.00, and a check-up exam $39.00, $44.47 and $68.00.

Those are programme allowances and a charging ceiling, not retail prices, and a practice may reasonably charge more. But if the included care in a membership is priced at several times the top of that band before the discount is applied, the discount is being taken off a larger number than it looks. The full set of routine lines gives you the rest of the ruler.

The question of whether you will use it

A membership is bought on an intention and used on a habit, and the two do not always match. Two included cleanings a year are worth nothing if only one of them happens, and the fee is charged either way.

The honest test is the last two years rather than the coming one. If you have not been to a dentist in three years, a membership is being bought as a commitment device, and commitment devices with a yearly fee attached are an expensive way to make an appointment.

The cheaper version of the same commitment is to book the appointment. If the reason you have not is cost rather than habit, the free and low-cost routes address that directly and without a fee.

There is a second version of the same test that is worth applying. Ask how many of the included visits you would have paid for anyway at that practice this year, and price only those. A membership is competing with the care you were already going to buy, and everything beyond that is a discount on treatment you have not yet been told you need.

What a membership cannot do

It does not travel. Leave the practice — move house, change job, fall out with them — and the membership is worth nothing at the next one. That is the main structural difference from a discount plan, which at least runs across a network of dentists.

It also does not protect you from a large unexpected bill in the way cover does. A percentage off a four-figure treatment plan is still most of a four-figure treatment plan, and the membership has no maximum, no stop-loss and no reimbursement behind it.

Five things to read in the terms

The fee and the percentage are the two numbers in the advertisement. These five are the ones that decide whether the plan behaves the way you expect it to.

1. How it renews. Automatically, on what date, and with what notice of a price change.
2. How it cancels. Mid-year, and whether anything is refunded if you have used the included visits.
3. Who is covered. One person, or a household, and at what fee for each additional person.
4. Whether the discount applies to specialist work. Often it does not, and specialist work is the expensive kind.
5. What is excluded outright. Cosmetic treatment and laboratory fees are the two most common exclusions, and laboratory fees can be a substantial part of a crown or a denture.

None of those is a trick question and a straightforward plan answers all five on one page. A plan that cannot be handed over in writing before you join has told you something about how the rest of it will go.

Ask as well whether the membership price is the same for a new patient as for an existing one, and whether joining commits you to a course of treatment. Neither should be true, and both occasionally are.

Membership, discount plan, or neither

A membership suits somebody who goes to one practice regularly and mostly needs routine care there. A discount plan suits somebody facing a specific expensive treatment where the network's fee list covers it and a reachable dentist has signed that network. Neither suits somebody who is not sure yet what they need.

If you are weighing a plan against borrowing, that comparison is worked through separately. If you are weighing everything at once, the full ladder of ways to pay is the place to start, and the prices underneath all of it are what any of these is a discount on.