Capitation

Capitation programs, sometimes known as Dental HMO plans, are a type of managed care plan. In these types of plans, the dentist is paid a fixed amount (usually monthly) per capita (per patient) or family rather than for actual treatment provided. In return, the dentist agrees to provide specific types of treatment to patients at no charge (for some treatments there may be a patient co-payment).

The capitation premium that is paid to the dentist may differ greatly from the amount the plan provides for patients’ actual dental care.

Your primary dentist may be considered by the plan to be a “gatekeeper” to specialists or other services. The plan may discourage or limit referrals to specialists.

Your MDS dentist wants you to know that capitation plans will allow you only to see a dentist in your plan’s network and will not provide any coverage for treatment provided by non-participating dentists.