Visits to the dentist are essential for maintaining oral health. However, many people feel uneasy about dental visits. This is not because of the treatment but because they worry about the cost. Dental insurance can provide valuable support, and Summit Dental Partners is here to guide you through your options.

We participate in many major dental insurance plans so that you can pay for your dental work with insurance. If you don’t have dental insurance, Summit Dental Partners has a unique membership program.

Our friendly team is always here to help. We can assist with scheduling and answer any questions you have. We want to make sure you understand your coverage and options.

What Is Dental Insurance?

Oral health is vital to your overall health, but most medical insurance policies don’t cover dental work. Several companies offer supplemental dental insurance to cover cosmetic and family dentistry. The policy can be an add-on to your medical insurance or a separate one.

Dental insurance works like medical insurance, covering different treatments and medications based on your plan.

Your coverage depends on whether your dentist, orthodontist, or oral surgeon is “in-network” or “out-of-network.” Most plans cover preventive care and treatments for gum disease.

They also help with common dental issues like cavities and root canals.

Dental insurance coverage is on a per-year basis, meaning your benefits and deductibles turn over every year. Most go by calendar year, meaning coverage turns over Jan. 1, but some go by enrollment date. Check with your provider to find out your turnover date.

Insurance and Cosmetic Dental Services

Cosmetic dental services can significantly enhance your smile—but what role does dental insurance play in covering these treatments? Many people look for dental insurance for cosmetic dentistry. This helps cover treatments like teeth whitening, veneers, and bonding costs. Understanding how cosmetic dentistry fits into your insurance plan can help you plan your care more effectively.

Most traditional dental insurance plans prioritize preventive and restorative care, like cleanings, fillings, and crowns. However, coverage for cosmetic dental procedures is often limited or not included.

Reviewing your plan’s details is essential if you’re looking for cosmetic dental insurance coverage. Many insurance plans do not cover cosmetic or orthodontic procedures. You may need to look for supplemental insurance for these treatments. Summit Dental Partners offers an in-house membership for affordable cosmetic dentistry and discounts on treatments like orthodontics.

Types of Dental Insurance

Many dental insurance plans are available. Knowing what you are signing up for will help you ensure that it meets your dental care needs.

Dental Insurance vs Dental Benefits

Some plans are full insurance that covers you in case you need an emergency procedure, such as a filling or root canal. Insurance plans have broad coverage but may have an annual cap.

Other plans may be “dental benefits” plans. Instead of covering everything, these plans only cover specific procedures and may entirely or partially cover them. A dental benefits plan offers a certain amount of money for each procedure, often rather than an annual cap.

Many employers offer benefits plans rather than complete insurance plans. Reviewing the terms of each policy will ensure it covers what you need.

DPPO vs. DHMO

Dental insurance plans, like medical plans, can be PPOs or HMOs. Both offer broader coverage than dental benefits but differ in several areas.

Dental HMOs

• They tend to have lower premiums than PPOs
• Have lower or no annual deductibles
• Have smaller networks
• Require a primary dentist
• Have little to no yearly maximum
• Often have no out-of-network coverage
• Require referrals for specialists like endodontists

Dental PPOs

• They have higher premiums than HMOs
• Have higher deductibles
• Have larger networks
• No primary dentist is required
• Usually have an annual maximum of $1,500 or less
• Include out-of-network coverage at a higher price than in-network
• No referrals are needed for specialists

FSAs and HSAs for Dental Expenses

Some medical plans include Flex Spending Accounts (FSAs) or Health Savings Accounts (HSAs). Both can be used for dental expenses not covered by your dental insurance or dental benefits plans.

However, while these plans sometimes cover over-the-counter medical supplies, they will not cover dental supplies. So don’t try buying toothpaste with your FSA card. It’s not going to work! However, you can typically use an FSA or HSA to care for that dental crown or braces.

If you’re wondering, “Can you use HSA for dental cosmetic services?” The answer is that it depends. HSA and FSA funds can be used for specific necessary dental treatments. However, they usually do not cover elective cosmetic services like teeth whitening.

In-Network vs. Out-of-Network Dental Partners

What do we mean by “in-network” vs. “out-of-network,” and what will it mean for your wallet? Insurance companies set up “networks” of dentists participating in your dental insurance plan. They list dentists, offices, and emergency locations where your insurance can be used at the standard rate.

Those outside your network are considered out-of-network dentists. You can still receive services from these locations, but it may cost you more, or specific procedures may not be covered. HMOs usually do not cover procedures done outside their network. This means you will pay the full cost, not just a part.

Your insurance provider should have a list of dentists in your network. Before getting insurance, make sure your general dentist is in your network. If not, consider choosing a new dentist from the list of approved providers.

No Dental Insurance? We’ve Got You Covered!

Don’t have dental insurance? Summit, NJ, residents without dental insurance can visit Summit Dental Partners. We offer an in-house membership plan for patients without access to dental insurance or a dental benefits plan.

Patients in our membership plan do not need to worry about deductibles. No waiting periods or pre-approvals are required. Also, there are no maximum coverage limits. Our plan offers a variety of benefits and savings on preventative, restorative, and orthodontic care.

Our membership plan makes cosmetic dentistry services, like teeth whitening, more affordable. Most insurance plans do not cover these treatments. Members gain access to family and cosmetic dentistry, including restorative treatments and orthodontic care.

Maximizing Your Dental Insurance and Benefits

With a new year comes new dental benefits, and it’s the perfect time to make the most of them. Here’s how to get started:

• Schedule Preventive Care Early
  Booking your cleanings, exams, and x-rays at the beginning of the year ensures you avoid the end-of-year rush. Early action helps you use benefits before deadlines.
• Use Your Fresh FSA or HSA Funds
  New funds will be available at the start of the year if you have a flexible spending account (FSA) or health savings account (HSA). Use them for out-of-pocket expenses like co-pays or non-covered treatments.
• Plan Treatments Wisely
  Split the procedures across two benefit years if you need extensive dental work, such as crowns, veneers, or root canals. This way, you can make the most of your new deductible and avoid exceeding your annual maximum.
• Keep an Eye on Your Annual Maximum
  Many dental insurance plans have an annual maximum, which is the most your plan will pay in a year. If you have treatments that need to be done, prioritize them before you hit the limit.
• Book Early to Beat the Year-End Rush
  Don’t wait until the last minute to use your benefits. Schedule your appointments early to avoid the year-end rush for available spots.
• Consult with Dental Experts
  Consulting with a dental expert can help you explore general, restorative, and cosmetic treatment options, including fillings, crowns, porcelain veneers, dental implants, and teeth whitening. Our dentists create a treatment plan that fits your schedule, addresses your unique needs, and aligns with your insurance coverage.

Paying for Dental Services in Summit, NJ

Navigating dental insurance can feel overwhelming, but Summit Dental Partners in Summit, NJ, is here to make it simple. We’ll help you understand your dental coverage and ensure you get the most from your benefits. If needed, we also offer access to our in-house membership plan.

We aim to help you achieve a healthy mouth and a confident smile—stress-free. Schedule your appointment with Summit Dental Partners in Summit, NJ, today and discover how easy dental care can be.