Concierge Dentistry: How Membership and Direct-Pay Dental Care Works

What the term means

"Concierge dentistry" has no official definition. Dental practices use it, along with "membership dentistry" and "boutique dentistry," to describe care that patients pay for directly instead of through a dental insurance plan.

These practices commonly describe:

• Longer, unhurried appointments
• The same dentist at every visit
• Easier scheduling and direct contact with the office
• Payment by visit or by a monthly or annual membership

As with medical practices, these are descriptions, not guarantees. What you receive depends on the individual practice.

Varies by practice. There is no standard for what "concierge" means in dentistry. Ask what the fee includes, who provides your care, and how treatment outside the membership is priced.

How a dental membership usually works

The most common arrangement behind the label is an in-office dental plan. The American Dental Association describes it this way: the patient pays the dental office a fixed amount on a monthly or annual basis and generally receives preventive services at no charge, with other procedures offered at a discounted fee. The ADA notes that the same arrangement is sometimes called a dental membership savings plan or a direct primary care agreement.

In practice, that usually means two parts:

• Included services. Preventive care, such as exams and cleanings, up to the number of visits the plan states.
• Discounted services. Other treatment at a reduced fee, which you pay when you receive it.

Each practice writes its own plan. The California Dental Association compares these plans to warehouse club memberships and notes that they can vary from one dental practice to another.

A membership is not dental insurance

This is the point most worth understanding before you pay. The California Dental Association states it plainly: an in-office discount plan is not an insurance plan.

Neither is better by definition. A membership can suit someone without dental benefits who intends to stay with one office. It does not help with treatment from a specialist the office refers you to, or with care while you are away from home.

How states regulate dental memberships

There is no single national rule. The ADA's guidance for dentists includes a list of regulations by state, which reflects how much the rules differ. In California, for example, the dental association reports that the Department of Managed Health Care has authority to regulate discount health plans.

For you, this means the protections that apply to a membership depend on where you live. Ask for the agreement in writing, and contact your state insurance department or consumer protection office if you have a question the practice cannot answer.

Concierge dentistry and your dental insurance

Some membership practices do not work with dental insurance at all. Others accept insurance and offer a membership to patients who have none. Ask which applies before you assume you can combine them.

If you buy health coverage through the Marketplace, be aware that adult dental care is treated separately. According to HealthCare.gov, dental coverage is not an essential health benefit for adults, so health plans do not have to offer it. Dental coverage is an essential health benefit for children 18 and under, which means it must be available for a child, either within a health plan or as a separate dental plan.

Before joining a membership, find out what dental benefits you already have. If your employer or plan already pays for cleanings and exams, a membership that includes the same services may add little.

Medicare and dental care

Medicare's dental rules are narrow, and a membership does not widen them.

Medicare does not cover most dental services, such as routine cleanings, fillings, and tooth extractions, and it does not cover dentures or implants. Medicare.gov states that you pay all costs in most cases.

Medicare may cover some dental services in limited situations, including:

• Dental services during a hospital inpatient stay, because of an underlying medical condition or the severity of the procedure
• An oral exam and dental treatment before certain covered treatments, such as a heart valve replacement or a transplant
• Treatment for a complication during head and neck cancer treatment
• Dental or oral exams connected with Medicare-covered dialysis for End-Stage Renal Disease

How this differs from physical therapy

Because routine dental care is generally outside Medicare, paying a dentist directly for a cleaning or a filling is ordinary. That is different from concierge physical therapy, where much of the care is Medicare-covered and must be billed to Medicare.

The opt-out rules also differ. The Centers for Medicare & Medicaid Services lists doctors of dental surgery or dental medicine among the providers who are eligible to opt out of Medicare. Physical therapists are on the list of those who are not.

What this means for you

• If you have Medicare, expect to pay for routine dental care yourself, with or without a membership.
• If you need one of the dental services Medicare may cover, ask the dentist whether they are enrolled in Medicare or have opted out, because that affects whether Medicare can pay.
• If you have other coverage alongside Medicare, check what dental benefits it includes before you add a membership fee.

HSAs, FSAs, and taxes

IRS Publication 502 says you can include in medical expenses the amounts you pay for the prevention and alleviation of dental disease. Its examples include teeth cleaning, sealants, fluoride treatments, X-rays, fillings, braces, extractions, and dentures. It also states that amounts paid to whiten teeth cannot be included.

Two cautions apply to memberships:

• The publication does not address dental membership fees. A fee that bundles preventive care with access to discounts is not listed either way.
• Payments for future care are limited. Publication 502 says that, generally, current payments for medical care to be provided substantially beyond the end of the year cannot be included.

Ask your health savings account or flexible spending account administrator, or a tax professional, how a membership fee is treated before you count on using those funds.

What does it cost?

Fees are set by each practice, and we have not found a reliable published survey to cite, so we do not quote a typical figure. Ask for:

• The monthly or annual fee, and whether a family rate exists
• Exactly which services are included, and how many visits
• The discounted fee schedule for other treatment
• Whether services such as X-rays, deep cleanings, or emergency visits are included or extra
• The cancellation and refund policy

Then compare the yearly total with what you would pay the same office without a membership, and with any dental insurance available to you.

Checking a dentist's license

Dentists are licensed by each state. The American Dental Association explains that a state board of dentistry sets the qualifications for licensure, issues licenses, and takes disciplinary action against those who engage in misconduct. Its state dental boards page lists the board for every state and the District of Columbia, with a link to each board's website.

Use your state board's site to confirm that the dentist holds a current license. If the practice advertises a specialty, ask what training and credentials support it.

Questions to ask before you join

1. What does the membership fee include, and can I see the list in writing?
2. How many exams and cleanings are included each year?
3. What discount applies to other treatment, and what are the prices after the discount?
4. Is the membership valid at more than one location?
5. Do you accept dental insurance, and can a membership be used with it?
6. What happens if you refer me to a specialist?
7. How are after-hours dental emergencies handled?
8. What are the cancellation and refund terms if I move or stop early?

Where dentistry fits with concierge medicine

Dentistry is one of several services now offered on a membership or direct-pay basis. A dental membership covers dental care only, so it does not replace health insurance or a primary care clinician. For the wider picture, see concierge medicine specialties. For how memberships relate to your coverage in general, see does insurance cover concierge medicine?