Dental Practices

ICHRA for Dental Practices

Whether it's a single-doctor practice or a multi-location DSO, dental practices tend to run small, stable staffs — dentists, hygienists, assistants, and front office — that still need competitive benefits to compete for talent, without the practice owner taking on a full HR and benefits administration function.

The Problem

Why group plans struggle here

A small single-location practice often can't get a competitive group health quote at all — many carriers set informal or formal minimums that a 6–12 person practice doesn't clear, or the rates simply aren't attractive at that size. Multi-location DSOs face a different problem: coordinating a group plan across several offices, sometimes in different rating areas, adds administrative complexity that a practice-focused management team usually isn't built to handle well.

The Fix

How Dental Practices employers use ICHRA

No minimum group size — works for a solo practice with a handful of staff as well as it does for a multi-location DSO
Simple to extend across multiple practice locations with one plan document, adjusting contribution by geographic rating area where needed
A genuine, budgetable benefit to help retain hygienists and assistants in a competitive local hiring market, without adding HR administration overhead
Owners can set higher contributions for clinical staff they most want to retain, and a different level for front office or part-time staff

Sample Structure

What a class structure might look like

Every plan is designed around the specific business, but here's a representative starting point for dental practices:

Employee class	Who's typically in it	Example monthly contribution
Dentist(s)/owner	Practice owner and any associate dentists	$500–$650/mo
Full-time clinical staff	Hygienists, dental assistants at 30+ hrs/week	$350–$450/mo
Part-time/front office	Part-time front desk or administrative staff	Typically excluded or smaller stipend

Figures are illustrative starting ranges, not quotes — actual contribution levels depend on budget, local plan costs, and ACA affordability requirements where applicable.

Worked Example

Example: a three-location dental service organization

A DSO operates three practice locations with 18 total employees — 2 dentist-owners, 10 full-time clinical staff, and 6 front office/part-time staff across the locations. A group plan was difficult to quote competitively given the small headcount at each individual location, and coordinating enrollment across three offices added real administrative friction. Under ICHRA, the DSO set contributions of $550/month for the owner-dentists and $400/month for full-time clinical staff, with part-time front office roles excluded from the class. One plan document now covers all three locations, with the practice manager handling far less day-to-day benefits administration than the group plan required.

Watch Out For

Common mistakes in dental practices

S-corp owners should confirm their own eligibility before assuming they can participate in the practice's ICHRA — IRS rules generally allow C-corp owners to participate as employees but restrict S-corp owners, which catches many practice owners by surprise
Multi-location DSOs forgetting that contribution amounts may need to vary by geographic rating area if locations are in meaningfully different markets
Not budgeting enough time to walk clinical staff through shopping the individual marketplace for the first time — this is often the first time these employees have had to choose their own plan

Frequently Asked

Dental Practices + ICHRA questions

Can the practice owner participate in the ICHRA if the practice is an S-corp?

Generally not directly as an owner — IRS rules around S-corp owner eligibility for HRAs differ from C-corp owners. This is worth confirming with a broker or tax advisor based on the practice's specific structure.

Does ICHRA work for a single-dentist practice with 5 employees?

Yes — there's no minimum group size, which is often the main reason a very small practice can offer a real benefit at all.

Can we set different contributions for hygienists versus dental assistants?

Only if they're defined as genuinely separate classes under permitted criteria — job title alone isn't one of the permitted class criteria, so this typically needs to be structured around salaried/hourly or full-time/part-time distinctions instead.