Will Patients Really Abandon Insurance for a Valuable Membership Plan?

By Michelle Maddox January 7, 2021 4 min read

We always get the same question: why would a patient buy into a membership plan over an insurance policy? It’s a great question! When office managers, hygienists and the dentist can speak to the higher value of the membership program, it really becomes a no brainer for the patient. And it makes growing the membership plan so much easier.

When we are speaking with these providers, they are usually want to build these programs and plans for one of three reasons.

  1. Retain current patients. They already have the relationship with the patient but maybe they are going through life changes affecting their insurance coverage. Membership plans are life proof! They do not rely on a job or spouse – only the relationship between patient and practice.
  2. Attract new patients. Obviously not everyone has insurance to begin with. Dentists that offer membership plans provide quality dental care for a transparent and affordable fee. That is very attractive for patients and consumers and why membership programs like Amazon Prime and Costco are so popular.
  3. Reduce PPO dependency and/or increase profitability. It is no secret that there is a major cost to participating with PPOs. It is incredibly time consuming and the write-offs are significant. Many dentists want to increase or build up their membership patient base so as they begin to eliminate PPOs. They have already begun to replace what they might lose at an even higher margin. This also gives patients an affordable option if they suddenly find themselves out of network and want to stay with the practice.

Let’s look at one example of an insurance plan.

This plan offers a $1000 maximum benefit, and the monthly premium is $30. For simplicity, we’ll say the two recall appointments are covered at 100% with no out-of-pocket cost to the patient.

Now let’s say the patient has a $3000 treatment plan, (i.e. two crowns). This insurance plan covers major restorative procedures at 50%. The plan has a $100 deductible and the insurance company has already covered the two recall appointments (roughly $400 total). So, now we need to factor in the remaining benefits.

After all of that is taken into consideration, the patients out of pocket for the year is $2400 for treatment PLUS their $30/month premium: $2815.

Now let’s take the same patient but put them into a membership plan.

An average monthly membership fee is $30 per month for an adult and a common discount for membership patients is 20% for restorative procedures. Their membership benefits include two recall appointments. Remember: same patient, same $3000 treatment plan. Factoring in the 20% discount for the crowns, the patient’s total out of pocket for the year is slightly less: $2400 for treatment and $360 in membership fees: $2760.

To dig a little deeper, typically membership plans include things like adult fluoride, limited exams, PAs or a pano when needed for no additional out-of-pocket expense to the patient. More and more, dentists are including things like sealants for kids or custom whitening trays. A membership plan is not only more economical, but it is certainly the best plan for optimal health and is most beneficial for the practice!

Dr. Flannagan has been using a membership plan in his office for over 8 years.

When people ask him what the biggest advantages are for a dental membership plan, he tells them, “two things: Price transparency and time savings. The patient knows what it’s going to cost, we know what’s its going to cost. The care we provide is explicitly stated as well as the price; for $30 a month you get this, this and this. Everything after that is discounted 20%. Simple.

“When I tell my team during our morning huddle that this patient and this patient are coming in and they are membership patients there are literally high fives going around. We don’t have to worry about what limitations there are going to be with the insurance plan, whether we are in network or out. We don’t have to worry about an annual maximum benefit, we don’t have to worry about if fluoride is going to be covered. And we as dentists like to say it’s our patient’s job to know their benefits, and it is. But the reality is that they rely on us because we know the details. It is a service we provide to our patients. Giving them the best estimate is tough and it is getting tougher and tougher every day.

“Working with a company like Plan Forward has made our membership plan so much better and more profitable. My goal all along with a membership program was to be able to pay my rent at my office, and we are doing that and then some! Having software to facilitate the process has been extremely helpful and the experience that the Plan Forward team brings to the table was critical in our plan’s success.”

Another benefit that our providers see, including Dr. Flannagan’s practice, is a change in patients’ habits.

Membership patients on average spend 2-3x more on their oral health than insurance and cash paying patients. The reason? It’s just like an Amazon Prime membership; you order more from Amazon because it’s convenient, easy and you are already paying for the service so you might as well use it. Same thing with a dental membership plan. Dental care becomes more convenient and easier. Patient’s want to get what they pay for AND they know it’s for the benefit of their health.

Membership plans grow loyalty with patients as well. Humans are creatures of habit and crave relationships! They WANT a dentist who knows their mouth and their health. The numbers are great but it is the intangibles that really push a membership vs an insurance plan, into the lead.

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