Find out what your insurance covers
Tell us which carrier you have and the best time to reach you — we will call back to verify your specific benefits over a brief, secure phone conversation.
Want to verify right now? Call (561) 295-3430 — we can pull your benefits while you're on the line.
- Insurance carriers we accept
- PPO vs HMO vs Discount plans
- In-network vs out-of-network at Sunset Smiles
- How to verify your benefits (free)
- Dental insurance terms explained
- Real cost examples with insurance
- Major Palm Beach County employers
- No insurance? Your options
- Medicare, Medicaid & FL Healthy Kids
- Common insurance questions
Dental insurance is one of the most confusing parts of getting care. Two patients with "the same" plan can have totally different out-of-pocket costs depending on their employer's contract, their annual maximum, what's been used this year, and which procedures fall under which coverage category. Our front-desk team verifies your benefits for free before your first visit — so you'll know exactly what's covered before any treatment begins.
Below: every carrier we work with, how each plan type really works, what specific terms on your benefits statement mean, and what a typical visit actually costs with insurance at Sunset Smiles.
Want a quick benefits check?
We'll verify your coverage within one business day — free, no obligation, no commitment to book.
Verify My Benefits Call (561) 295-3430Insurance carriers we accept
We accept most major PPO insurance plans as an out-of-network provider. We file claims directly with your carrier so you don't have to deal with paperwork or reimbursement on your own. Don't see your plan listed? Call us — we likely accept it.
Delta Dental
One of the largest dental insurance carriers in the U.S. and Florida. We accept Delta Dental PPO, Delta Premier, and Delta Dental of Florida plans. Typical Delta PPO coverage: preventive 100%, basic 80%, major 50%, with annual maximums ranging from $1,000–$2,000.
Note: Delta PPO and Delta Premier are different networks with different reimbursement rates. We'll verify which network applies to your specific plan.
Cigna Dental
We accept Cigna Dental PPO and Cigna Dental Care plans. Cigna typically covers preventive at 100%, basic at 80%, major restorative at 50%, with annual maximums of $1,000–$1,500. Cigna offers strong cosmetic coverage on certain employer plans — we'll verify if veneers or whitening are covered for you.
Aetna Dental
We accept Aetna Dental PPO Max, Aetna Dental Direct, and most other Aetna PPO plans. Typical coverage: preventive 100%, basic 80%, major 50%. Aetna often has lower annual maximums than other carriers ($1,000–$1,500), so we recommend planning major treatment carefully.
BlueCross BlueShield / Florida Blue
We accept BlueCross BlueShield Federal Employee Program (FEP), Florida Blue, and most BCBS PPO dental plans. Coverage varies significantly by plan — Florida Blue's BlueCare Dental plans often have $1,500 annual maximums with strong preventive coverage. Federal employees on the FEDVIP dental plan are well-covered for major work.
MetLife MetLife Dental
We accept MetLife PDP (Preferred Dentist Program) and MetLife Federal Dental. MetLife typically offers strong major coverage (often 60% vs the industry-standard 50%), making them one of the better plans for crowns, implants, and other significant restorative work.
Guardian Dental
We accept Guardian Dental PPO plans. Guardian frequently offers strong cosmetic and orthodontic coverage compared to other carriers — Invisalign is often partially covered. Annual maximums commonly $1,500–$2,000.
Humana Dental
We accept Humana Dental PPO. Coverage is typical for the industry (100/80/50 splits), with annual maximums $1,000–$1,500. Humana also offers a "Loyalty Plus" feature where your annual maximum increases each year you stay enrolled, which can be valuable for patients planning major work.
Florida Combined Life
The dental subsidiary of Florida Blue. We accept Florida Combined Life dental plans, which are commonly offered through Florida employers. Coverage is similar to Florida Blue plans.
Careington
Careington is a discount dental plan, not traditional insurance. Members pay a set fee per procedure rather than receiving insurance reimbursement. We participate in Careington's network and honor their negotiated rates — call us to confirm your plan tier.
Other carriers we commonly work with (filed on out-of-network basis): United Concordia, Principal, Ameritas, Lincoln Financial, Sun Life Dental, Anthem Dental, United Healthcare Dental, and most regional Florida plans. Call (561) 295-3430 with your insurance card and we'll confirm in 60 seconds.
PPO vs HMO vs Discount plans
Not all "dental insurance" works the same way. Understanding what type of plan you have matters because it determines how much you actually pay.
| Plan Type | How it works | At Sunset Smiles |
|---|---|---|
| PPO (Preferred Provider Organization) | Most common type. You can see any dentist; you pay less in-network, more out-of-network. Annual max, deductibles, and copay percentages apply. | ✅ We accept and file claims for all major PPO plans. Most patients still receive significant reimbursement on out-of-network visits. |
| HMO / DMO (Dental Maintenance Org) | Lower premiums, but you must use in-network providers only. No reimbursement for out-of-network care. | ❌ HMO/DMO plans only pay for in-network care. We do not participate in any DMO networks. |
| Indemnity (Traditional Insurance) | Rare today. Reimburses a percentage of usual-and-customary fees with no network restrictions. | ✅ We file these claims directly. Reimbursement varies widely by plan. |
| Discount Plan | Not insurance. You pay a membership fee for access to negotiated rates with participating dentists. No reimbursement, no annual max. | ⚠️ We participate in select discount networks (e.g., Careington). Confirm your plan tier with us. |
| Membership Plan (in-house) | Our own program for patients without insurance. Flat monthly fee covers preventive care plus 20% off everything else. | ✅ Sunset Smiles offers plans from $30/month. See details below. |
In-network vs out-of-network at Sunset Smiles
We are out-of-network for most plans. This is a deliberate choice that benefits patients in three important ways:
Not bound by insurance fees
In-network providers accept whatever rate the insurer sets — which often means rushing patients through 30-minute slots or using lower-cost materials to stay profitable. Out-of-network lets us take a full hour and use the materials we believe in.
Reimbursement often comes to you
When we file your claim, the insurance company can send the reimbursement directly to you, then you pay us for the visit. Many patients prefer this — you get the money first.
You still get real benefits
Out-of-network doesn't mean uncovered. The carrier reimburses at their out-of-network rate — typically 70–90% of the in-network amount. We'll show you the actual numbers before treatment.
The "in-network discount" trap: Some patients believe in-network providers are automatically cheaper. In reality, the fees you pay after reimbursement are often similar — and sometimes higher in-network because insurance dictates which procedures are "medically necessary." Out-of-network providers can quote the right treatment, not the insurance-approved one.
How to verify your benefits — free
The fastest way to know what your insurance will cover at Sunset Smiles: submit your info below or call us with your insurance card. We'll verify within one business day at no charge, with no obligation to book.
Call us
Call (561) 295-3430 with your insurance card handy — the fastest option, usually verified while you're on the phone.
Email a photo
Send a photo of the front and back of your insurance card to info@sunsetsmilesjupiter.com and we'll call you back with your benefits breakdown.
Online form
Use the verification form on our home page or contact page — submit your details and we'll respond within one business day.
What you'll get back: your annual maximum, your deductible (used and remaining), which procedure categories are covered, your copay percentages, frequency limitations on cleanings and X-rays, any waiting periods, missing tooth clause status, and whether cosmetic procedures (whitening, veneers) are covered or excluded.
Dental insurance terms explained
If your benefits statement looks like alphabet soup, you're not alone. Here's a plain-English guide to the terms that matter:
Annual Maximum
Deductible
Preventive / Basic / Major (the 100/80/50 split)
Most PPO plans divide dental care into three categories with different reimbursement levels:
- Preventive (100% covered): Cleanings, exams, X-rays, fluoride.
- Basic (80% covered): Fillings, extractions, root canals, periodontal cleaning.
- Major (50% covered): Crowns, bridges, dentures, sometimes implants.
"Covered" here means after your deductible. Cosmetic procedures (whitening, veneers, smile makeovers) are usually not covered at all.
Frequency Limitations
Waiting Period
Missing Tooth Clause
UCR (Usual, Customary, & Reasonable)
EOB (Explanation of Benefits)
Pre-authorization / Pre-determination
Real cost examples with insurance
Here's what typical Sunset Smiles patients pay out-of-pocket for common procedures, assuming a standard PPO plan (100/80/50 split, $50 deductible already met, $1,500 annual max):
| Procedure | Typical Fee | Insurance Pays | You Pay |
|---|---|---|---|
| Cleaning + exam + X-rays | $285 | $285 (100%) | $0 |
| Composite filling (1 tooth) | $220 | $176 (80%) | $44 |
| Root canal (molar) | $1,400 | $700 (50% — major) | $700 |
| Ceramic crown | $1,650 | $825 (50% — major) | $825 |
| Single dental implant | $4,500 | $1,500 (capped at annual max) | $3,000 |
| Porcelain veneer (cosmetic) | $1,800 | $0 (not covered — cosmetic) | $1,800 |
| ZOOM whitening (cosmetic) | $575 | $0 (not covered — cosmetic) | $575 |
These are typical ranges. Your actual out-of-pocket depends on your specific plan, where you are in your annual max, and the exact treatment needed. We'll provide a precise estimate at your consultation — always before any work begins.
Major Palm Beach County employers
Most of our patients come from Palm Beach County's major employer base. We accept dental plans from all of them and routinely handle the specifics of their benefits structures. Below: the employers we see most often, and details that matter to their employees.
NextEra Energy / FPL employees
NextEra Energy (headquartered in Juno Beach) and Florida Power & Light have one of the most generous dental benefits structures of any major Florida employer. Two details worth knowing if you work there:
- Preventive care is typically covered at 100%. Your routine cleanings, exams, and digital X-rays should cost you nothing out of pocket on most NextEra dental plan elections — we file claims directly with your carrier and you should owe $0 for a standard recare visit.
- HSA wellness incentive — up to $350 for completing a dental checkup. If you're enrolled in a NextEra HSA-eligible plan, completing your annual dental checkup typically qualifies for a wellness incentive deposit (recent benefit year: $350) into your HSA. We provide all the documentation your benefits portal requires to claim it — just let our front desk know when you book that you'll need wellness incentive paperwork.
Why we know the NextEra benefits structure: Dr. Martinez's family includes a NextEra employee, so the practice has first-hand familiarity with how the dental coverage, HSA wellness incentive, and open enrollment options work in practice. If you have questions about how your specific plan election interacts with treatment we're recommending, just ask — we've navigated the same paperwork.
Benefit details may change year to year — confirm specifics with NextEra HR or your current benefits guide. Sunset Smiles Cosmetic Dentistry is not affiliated with or endorsed by NextEra Energy or Florida Power & Light.
Other major Palm Beach County employers we frequently work with
We routinely work with patients from these and other large local employers:
- Pratt & Whitney (Jupiter / West Palm Beach)
- Jupiter Medical Center and other healthcare systems
- Palm Beach County School District
- Palm Beach County government
- The Town of Jupiter / Town of Tequesta
- The Scripps Research Institute
- Hospital systems — Tenet, HCA Florida, Cleveland Clinic Florida
- Federal employees on FEDVIP dental plans (MetLife, BCBS FEP, Delta Dental Federal)
Whichever employer you work for, we'll verify your benefits before your first visit — call us at (561) 295-3430 with your insurance card and we'll confirm coverage in 60 seconds.
No insurance? No problem.
If you're between jobs, self-employed, retired, or just don't carry dental insurance, you have three excellent options at Sunset Smiles:
In-house membership plan
Covers all your preventive care (cleanings, exams, X-rays) and gives you 20% off everything else — fillings, crowns, veneers, implants, whitening. No annual max, no deductibles, no waiting periods, no cosmetic exclusions.
See full plan details →Cherry financing
For larger treatment like implants, veneers, or smile makeovers, Cherry offers monthly payment plans starting at 0% APR. Pre-qualification takes 60 seconds and doesn't affect your credit. Amounts from $200 to $50,000.
Apply with Cherry →$149 New Patient Special
First-time patients without insurance get a comprehensive exam, full digital X-rays, and a professional cleaning — saving about $150 versus paying per procedure.
Learn more →Medicare, Medicaid & FL Healthy Kids
This is a common question, so let's address it directly:
Original Medicare
We do not accept Medicare. However, original Medicare (Parts A and B) doesn't cover routine dental care anyway — cleanings, fillings, crowns, dentures, and most dental procedures are excluded. Medicare only covers dental care that's medically necessary (e.g., dental work prior to heart surgery).
Medicare Advantage with dental benefits
Some Medicare Advantage (Part C) plans include dental coverage. Coverage varies wildly by plan and insurer. If you have a Medicare Advantage plan with dental benefits, call us at (561) 295-3430 with your plan details — we may be able to file an out-of-network claim, but cannot guarantee coverage.
Florida Medicaid (Healthy Kids, MMA)
We do not accept Florida Medicaid plans including Florida Healthy Kids, Sunshine Health, Staywell, or any Medicaid Managed Care Assistance program. For Medicaid-covered dental care, contact your Medicaid managed care plan directly for a list of participating providers.
VA / Veterans Affairs
We do not directly accept VA dental benefits. If you are a veteran with Community Care authorization or VA Dental Insurance Program (VADIP) coverage through Delta Dental or MetLife, contact us to discuss your specific authorization.
Common insurance questions
How does the NextEra HSA wellness incentive work with a dental checkup?
Will my insurance cover veneers or whitening?
Why is the bill higher than my insurance "estimate" said?
If I switch insurance mid-treatment, what happens?
Can I use my FSA or HSA for dental work?
What if I have two dental insurance plans?
Do you offer payment plans for the patient portion?
Have a coverage question we didn't answer?
Our front-desk team handles insurance questions every day. Call us with your card and we'll walk you through your specific plan.
Call (561) 295-3430 Send a Message