Dental Insurance – Encinitas

Maximize Your Dental Insurance Benefits

Dental insurance is an incredibly helpful tool to make dental care affordable for you and your family! Dental insurance is quite a bit different than the medical insurance that you are used to, so navigating it can be a little bit confusing. To benefit from your dental insurance plan, it’s important that you are taking all the right steps to completely maximize your benefits. To learn more about dental insurance and how it works, keep reading. If you have any questions or concerns, don’t hesitate to give us a call. We’d be more than happy to help.

How Dental Insurance Works

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You pay for your dental insurance plan with your monthly premiums. This way, you receive discounts on dental care. Here is what you can generally expect in terms of coverage by service:

  • Preventive dental treatments are usually covered at 100%. This includes things like checkups, cleanings, and X-rays.
  • Basic restorative procedures are usually covered at around 80%. This includes dental fillings.
  • Major restorative procedures are usually covered at about 50%. This includes things like dental crowns, dentures, and tooth extractions.

In the vast majority of cases, cosmetic procedures are not covered because they are considered to be elective. The idea is that by attending your cleanings and checkups, you can prevent the need for restorative treatments in the future, which aren’t covered at as high of a rate. However, there are still some key points to remember:

  • Most dental insurance plans are renewed at the beginning of the calendar year, and benefits do not roll over.
  • You must meet your deductible before your insurance company will agree to pay more for any minor or major restorative procedures.
  • Your annual maximum is the designated amount of money provided to you by your insurance company. This is the most they will agree to pay out in a single year. If you do not reach this amount, the remaining money is returned to your insurance company.

What’s the Difference Between Dental & Medical Insurance?

Medical insurance and dental insurance may seem like they would be similar, but they have quite a few differences. The biggest one is that dental insurance is focused more on preventive care. That’s why most plans include complete coverage for cleanings and checkups. This way, patients can avoid needing more complex procedures, like root canals and extractions.

In-Network vs. Out-of-Network

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When you are choosing a dentist, it is key to know if they are in-network or out-of-network. Here’s what this means.

In-Network Coverage

If you choose an in-network dentist, this means that the dentist and insurance company have a contract to offer services at set fees. Choosing an in-network dentist is the best way to maximize your benefits. At McElroy Smiles by Design of Encinitas, we are in-network with:


Even if your insurance provider isn’t listed above, this doesn’t mean that you are out of luck in getting coverage. We likely still accept your plan and can still file paperwork on your behalf. This way, you can still get the same high-quality care at an affordable rate.