Navigating the financial aspects of your child’s dental care can sometimes feel as challenging as getting them to brush before bedtime. Between traditional dental insurance plans, out-of-network benefits, and membership options, many parents find themselves confused about the best way to manage their children’s dental expenses. At Little Roots Pediatric Dental, we believe that financial concerns should never be a barrier to quality pediatric dental care, which is why we’re committed to helping families understand their options.
At our Nassau County dental practice, we work with families to find the most practical financial solutions for their children’s dental needs, ensuring that quality care remains accessible regardless of insurance status.
The Basics of Dental Insurance for Children
Dental insurance works differently than medical insurance, which often surprises parents. Here’s what you need to know about traditional dental insurance plans:
How Dental Insurance Typically Works
Most dental insurance plans operate on a 100-80-50 coverage structure:
- 100% coverage for preventive care (regular cleanings, exams, x-rays)
- 80% coverage for basic procedures (fillings, extractions)
- 50% coverage for major procedures (crowns, root canals)
However, these percentages apply only after you’ve met your deductible, and coverage is limited by annual maximums—typically between $1,000-$2,000 per person per year.
In-Network vs. Out-of-Network Providers
One concept that often causes confusion is the distinction between in-network and out-of-network providers:
- In-network providers have contracted with insurance companies to accept predetermined fees for services
- Out-of-network providers like Little Roots Pediatric Dental haven’t signed such contracts but may still process your insurance benefits
While we may not be in-network with your insurance, we do process benefits on behalf of all PPO providers and quickly file claims to ensure patients receive maximum savings. This means you can still use your insurance benefits at our practice, even though we’re out-of-network.
Children’s Dental Coverage Through ACA and Medicaid
It’s worth noting that:
- The Affordable Care Act (ACA) requires dental coverage for children as an essential health benefit
- Children’s Medicaid and CHIP (Children’s Health Insurance Program) include dental benefits in most states
- These programs may have specific limitations and approved providers
Membership Plans: An Alternative Approach
For families without dental insurance or those looking for more predictable costs, membership plans offer an attractive alternative. Here’s how our membership plan works:
What Is a Dental Membership Plan?
A dental membership plan is a subscription-based program offered directly by dental practices. Unlike insurance, there are:
- No deductibles to meet
- No annual maximums
- No waiting periods
- No claim forms or rejections
Instead, you pay an annual or monthly fee that covers certain preventive services and provides discounts on other treatments.
Benefits of Membership Plans
Membership plans offer several advantages:
- Transparency: Clear pricing with no surprise fees or denied claims
- Simplicity: Easy to understand with no complicated insurance terms
- Immediate coverage: No waiting periods for treatment
- Predictable costs: Fixed fees make budgeting easier
- Consistent care: Encourages regular preventive visits
Little Roots Pediatric Dental Membership Plan
Our membership plan includes:
- Two comprehensive exams per year
- Two professional cleanings
- Necessary x-rays
- Fluoride treatments
- Significant discounts on additional treatments
- No annual maximums or claim forms
Comparing Costs: Insurance vs. Membership Plans
When evaluating the financial aspects of dental insurance versus membership plans, consider these factors:
Cost Breakdown for Insurance
- Monthly premiums (typically $20-$50 per month for family coverage)
- Annual deductible (often $50-$100 per person)
- Copays for each visit
- Out-of-pocket costs for treatment beyond annual maximums
- Waiting periods for certain procedures
Cost Breakdown for Membership Plans
- Annual membership fee
- Discounted rates on procedures beyond covered preventive care
- No deductibles or claim forms
- No annual maximums
For many families, especially those with children who primarily need preventive care with occasional treatments, membership plans can provide significant savings while simplifying the payment process.
Making the Right Choice for Your Family
The best financial approach for your child’s dental care depends on your specific situation. Consider these factors when deciding:
When Insurance Might Be Better
- If your employer offers dental insurance with significant subsidies
- If your child needs extensive dental work that exceeds the cost of premiums
- If you prefer having a nationwide network of providers
When a Membership Plan Might Be Better
- If you don’t have access to employer-sponsored dental insurance
- If your child primarily needs preventive care
- If you value simplicity and predictability in healthcare costs
- If you want to establish a long-term relationship with a specific dental practice
Creative Financing Options
Beyond insurance and membership plans, Little Roots Pediatric Dental offers additional financing options to fit treatment within your budget:
- Payment plans for more extensive treatments
- Credit card payments
- Flexible spending account (FSA) compatibility
- Health savings account (HSA) compatibility
Our Commitment to Affordable Care
At Little Roots Pediatric Dental, we believe that every child deserves quality dental care regardless of insurance status. While we may not be in-network with your insurance, we do process benefits on behalf of all PPO providers and quickly file claims to ensure patients receive maximum savings.
For families without insurance coverage, our membership plan provides an affordable alternative that encourages regular preventive care—the foundation of lifelong dental health.
Dr. Sunaina Vohra and Dr. Jessica Barzideh are committed to creating a welcoming and compassionate atmosphere for young patients. Our focus spans all areas of pediatric dentistry, with a particular interest in making quality dental care accessible to all families in our community.
We understand that navigating the financial aspects of healthcare can be confusing, and we’re here to help. Our front office team is experienced in explaining benefits and helping families make informed decisions about their children’s dental care.
For more information about our membership plan or how we work with insurance providers, contact us today at (516) 738-4434 or through our contact form to schedule a consultation at our Westbury, Long Island office.
