Dental Membership vs Dental Insurance

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There are many ways you can approach the financial side of dental care for your children. The most common is dental insurance. There are also dental discount plans, and a growing option of dental memberships (or in-house dental plans), like the Tam Teeth Club. Let’s make sense of the main differences between dental insurance and a dental membership plan.

What is a Dental Membership Plan?

Dental membership plans are created & managed by your dental office as an alternative to traditional insurance policies. They may also be referred to as an in-house dental plan or dental savings plan. These programs vary because they are created by a specific office, but generally will offer a specific set of services that help parents plan for kid’s preventative dental care. At Mt Tam Pediatric Dentistry, we offer a complete set of services + discounts on additional services for an annual cost.

What are the differences between a Dental Membership Plan and Dental Insurance?

Dental Membership Plans are like insurance policies in that they vary widely from one provider to another. However, that is where the similarities end. While it’s possible to get a Dental Discount Plan or Dental Membership that applies to a network of dentists, the most common Dental Membership setup is through an individual dental practice (or small set of practices). Commonly, a Dental Membership program is a win-win for patients and dental providers. They offer cost savings to patients directly from your chosen dentist, and remove confusing deductibles, coverage amounts, and reimbursement paperwork. For your dentist, the plans allow them to operate at a higher standard of care that insurance-required fees often don’t support - especially in higher cost markets (like the Bay Area).

Dental Memberships do need to make sense for you as the patient, so they should feature great benefits to encourage your loyalty. Dental insurance could make more sense for you based on your needs and options. For example, if you want to switch dentists, or if your insurance plan offers good reimbursements to out-of-network dentists, dental insurance could make more sense for your children.

Deep Dive: Dental Membership Plans and Dental Insurance

If you want to dive a bit deeper, here is how some of the specifics work for each option.

Families that receive dental insurance through their employer may have fewer concerns - but there is a growing trend of employers “checking the box” for employees by offering lower quality dental plans. For example, your employer may contract with a national insurance provider that offers a certain reimbursement amount no matter where the employees are based. If you are in California, your reimbursement may be the same as your colleagues in Illinois even though the costs are higher for dentists and patients in California. Additionally, you may be paying a small amount per paycheck to add your children to your plan. However, if you aren’t paying a lot, the plan likely doesn’t cover very much of the cost for their pediatric-dedicated care.

If your family does not have access to employer-sponsored dental coverage and you pay for dental insurance independently, then consider switching to a Dental Membership plan. Simply put, dental insurance plans are becoming more and more limiting. Non-employer, independent insurance plans are subject to a variety of barriers, including waiting periods, extensive paperwork, treatment limitations, and annual maximums. These limit quality of care and are time consuming to navigate.

Additionally, with a variety of insurance providers comes a variety of coverages and reimbursement amounts. Most insurance plans provide coverage for preventative care whether or not the dentist is in-network, however they also may only reimburse a small portion of the cost. In fact, some insurance plans don’t cover certain treatments that your kids may need; or they may only cover a small amount of what is needed. It is always a good idea to fully understand your coverage for the given dental office you are visiting - as it can vary office-to-office. 

A little known fact: when a dentist goes in network with a given insurance provider, they can only charge what the insurance provider allows - regardless of geographic region or the dentist’s regular fees. Quality dental care for children in the Bay Area cannot be supported by low reimbursements dictated by many common dental insurance companies. This is a reason why it is becoming increasingly difficult to find in-network dental specialists participating in many common dental insurance plans.

The Tam Team is happy to help you work with your insurance company to determine your coverage before your family’s visit. However, some insurance companies will only share specific cost amounts with their members, so you may need to reach out directly. As busy parents ourselves, we understand how frustrating it can be to deal with insurance companies - especially when you receive lower-than-expected coverage/reimbursement amounts. This is why we created our membership plan, the Tam Teeth Club.

Which option is better for me?

Ultimately, you should choose based on what your insurance options are and what your family needs. There is no one-size-fits-all answer to this question. According to the ADA, one of the biggest reasons that most people don’t go to the dentist is because of cost. We created the Tam Teeth Club to give our families access to a transparent preventative care plan for their children, that also provides discounts on additional treatment. It also helps our office continue to provide the highest standard of care while managing the rising costs of doing business in the Bay Area.

The Tam Team is here to help answer your family’s questions about our membership plan, or your insurance coverage as best as we can.