Understanding Dental Insurance & an Easier Alternative with Mequon Smile Design

Dental insurance can be confusing. While most people know they have coverage, many are unsure about the details—what’s included, how much is covered, and what they’ll owe out of pocket. Before undergoing any treatment, it’s important to understand how your dental benefits work to avoid unexpected expenses and make informed choices about your care.

Key Things to Know About Your Dental Insurance

1. Plan Coverage: Understand exactly what your dental insurance includes. Preventive care is often fully covered, but more extensive procedures may only be partially reimbursed.
2. Maximum Benefit: Allowance Every plan has a maximum dollar amount it will contribute each year. Once that limit is reached, you’re responsible for 100% of any remaining costs.
3. Coverage Timeline: Some plans follow a calendar year (January–December), while others are based on your enrollment or a plan year. Know your timeline so you can make the most of your benefits.
4. In-Network vs. Out-of-Network: Staying in-network often means lower out-of-pocket costs. If you choose an out-of-network provider, your insurance may reimburse less—or not at all.

In-Network Providers at Mequon Smile Design

To help you make the most of your benefits, here’s a breakdown of which insurance plans our doctors are in-network with:

• Dr. Julie and Dr. Sofia are in-network with: Aetna, Ameritas, Delta Dental, MetLife, Premier Dental Group, and Zelis
• Dr. Sofia only: United Healthcare Medicare Plan
• Dr. Julie only: Cigna DPPO

Not sure which provider you’re scheduled with or if your plan qualifies? Our front desk team is happy to help verify coverage prior to your appointment.

Insurance Contributions: What’s Actually Covered?

Most dental insurance plans cover 100% of preventive care, including cleanings, exams, and routine x-rays. However, restorative treatments—like fillings, crowns, and root canals—are typically only partially covered.

It’s essential to remember: insurance is a contribution, not a guarantee of full payment. Without a clear understanding, patients are often surprised by their out-of-pocket costs. That’s why we offer flexible payment and financing options to help bridge the gap.

A Simpler, Smarter Alternative: Mequon Smile Design Membership Plans

If you don’t have dental insurance—or if you’re frustrated with the limitations of your current plan—our Membership Plans offer a more transparent, budget-friendly way to receive care.

How It Works

Our membership plan is a subscription-style dental plan. For a low monthly fee, patients receive preventive care and exclusive discounts on other treatments—with no insurance middlemen involved.

What’s Included:

• Routine cleanings, exams, and x-rays at no extra charge
• Immediate activation—no waiting period
• Discounts on treatments like fillings, crowns, and more
• No annual maximums, deductibles, or pre-approvals

Starting at just $43/month for adults, our plans make dental care simple and predictable. You’ll know exactly what you’re paying and what you’re getting—with no claim denials or surprise bills.

Final Thoughts

Don’t let insurance confusion get in the way of your oral health. At Mequon Smile Design, we’re here to help you navigate your coverage—and provide affordable, high-quality care for every smile. Whether you have traditional insurance or are looking for an alternative like our Membership Plan, we’ll make sure you feel informed and empowered at every step.

Not sure where to start? Call us or schedule your visit—we’re happy to verify your benefits and help you choose the best care option for your smile.