Membership Plans Are Replacing PPOs. Here's How to Set One Up.

A dental membership plan is simple: patients pay you directly - usually $25-$45/month - and they get preventive care plus discounts on everything else. No insurance company in the middle. No write-offs. No denied claims.

It's not a new idea. But it's having a moment, and for good reason.

Why Membership Plans Work

Recurring revenue. 200 members at $35/month = $84,000/year in predictable income that hits your account whether patients show up or not. That's cash flow stability most practices dream about.

No write-offs. A PPO patient's crown generates $660 after a 45% write-off. A membership patient pays $960 (20% member discount on your $1,200 fee). That's $300 more per crown, and you don't wait 45 days for the check.

Better patient loyalty. Membership patients show up. They have skin in the game - they're paying monthly and they want to use what they're paying for. Retention rates run 80%+ compared to 60-70% for PPO patients.

No middleman. No pre-authorizations. No downcoding. No claim denials. No EOB confusion. You set the fee schedule. You control the experience.

Typical Pricing

Most successful plans land between $25-$45/month for adults. Here's what a typical plan includes:

• 2 cleanings per year (or 3-4 perio maintenance visits for perio patients)
• 2 exams per year
• Necessary x-rays (1 set of BWX, 1 pano per year)
• 15-20% off all other treatment
• No deductibles, no waiting periods, no annual maximums

At $35/month, a patient pays $420/year for preventive care. Compare that to dental insurance: the average individual dental insurance premium is $360-$600/year, with a $50-$100 deductible, a $1,000-$1,500 annual max, and coverage that still leaves patients paying 20-50% of major procedures.

Your membership plan is genuinely a better deal for most patients. And it's a dramatically better deal for you.

Sources: BoomCloud industry data, ADA membership plan surveys, Dental Economics

Step-by-Step Implementation

Step 1: Design Your Plan (Week 1)

Keep it simple. One adult plan. One perio plan. Optionally a child plan.

Step 2: Choose Your Software (Week 1-2)

If you're just testing the waters with 20-50 patients, start in-house with a simple Stripe recurring payment. Once you cross 50+ members, the automation from BoomCloud or Kleer pays for itself in admin time savings.

Step 3: Set Up Legal Compliance (Week 2-3)

Important: a membership plan is NOT insurance. But you need to make sure your state agrees. Key steps:

• Have a dental attorney review your membership agreement. Cost: $500-$1,500 one-time.
• Include clear language: "This is a discount plan, not insurance."
• Some states (TX, FL, CA) have specific discount plan regulations. Check with your state dental board.
• Include cancellation terms, auto-renewal disclosure, and refund policy.

Step 4: Train Your Team (Week 3)

Your front desk is the sales team. They need to know:

• Who to pitch: uninsured patients, patients with bad insurance, PPO patients you're transitioning
• The comparison: "Your insurance costs $480/year with a $1,500 max. Our plan is $420/year with no max on the discount."
• How to sign up a patient in under 3 minutes
• How to handle the objection: "I already have insurance" - "Great, you can use both. The membership discount applies to anything your insurance doesn't cover."

Step 5: Launch and Market (Week 4+)

Internal marketing (first 90 days):

• Every uninsured patient gets a membership plan pitch at checkout. Every single one.
• Place a sign-up iPad at the front desk with a QR code.
• Include a membership plan flyer in every new patient welcome packet.
• Train hygienists to mention it during prophys: "Did you know we have a membership plan that covers everything you got today?"

External marketing (ongoing):

• Add a membership plan page to your website with online signup.
• Run a Google Ads campaign targeting "dentist no insurance [your city]" - these patients are actively looking for you.
• Post on social media: compare your plan pricing to average insurance costs. The math sells itself.

Converting PPO Patients to Membership

This is where membership plans really shine - as a PPO exit strategy.

When you drop a PPO, every affected patient gets two choices: pay out-of-network rates or join your membership plan. Most patients find the membership plan cheaper than their out-of-network costs.

The conversion playbook:

1. 60 days before dropping a PPO, send the notification letter (see our PPO exit guide).
2. Include a membership plan comparison sheet showing the patient's current costs vs. membership costs.
3. Offer a "founding member" discount: first 3 months at $25/month instead of $35/month for patients who switch within 30 days.
4. Follow up by phone with your top 50 highest-value PPO patients. Personal calls convert at 3x the rate of letters.

Realistic Growth Expectations

The practices that go all-in on membership plans as a PPO replacement are building something most dental practices don't have: predictable, recurring revenue that doesn't depend on insurance companies, claim approvals, or reimbursement rates.

Related reading

• Membership Plans Are Eating PPO Margins. Start One or Lose
• Dental benefit plan design is getting worse, not better
• PPO Write-Offs: Your Insurance Carrier Is Stealing $42K/Year Per Doctor