Whether you need dental insurance or not, it really depends on whether you have a good set of teeth or not. My suggestion is, if you don’t have dental insurance, brush and floss your teeth well,  don’t hit it too hard when you play sports, eat something less tough, and if you have night molars, go to Walmart and get a night guard.

The dental insurance is divided into HMO and PPO.

• Both require you to go to the dentists in the dental provider network offered by the insurance company, but
• HMO’s insurance plan requires you  to designate a primary care dentist, who is normally a general dentist. General dentists mainly wash teeth, check, diagnose, fill teeth, etc. If you need specialist dentists such as orthodontist, endodontist, prosthodontist, etc., you must first go to your primary care dentist. He can then refer you to a specialist. Make sure you obtain the approval of the insurance company before going to the specialist.
• With PPO, you can go directly to the general or specialist dentist. Because the insurance company gives PPO dentists higher fee, most dentists prefer to join the PPO. There are more PPO practitioners to choose from than those in the HMO. Oftentimes the dentist you want is not in the HMO network, but in the PPO network. Therefore, PPO insurance tends to be more expensive than HMO.
• The HMO program has a fee schedule set by the insurance company, which lists the charge for each medical procedure item by item. When you go to the doctor, remember to bring it, so you can confirm whether the fee charged to you is correct. On the other hand, the PPO can be priced by the dentist, but within the rate approved by the insurance company.
• In general, HMO has no (insurance company’s) upper limit, but PPO has upper limit, which means maximum dollar amount that the insurance company would pay.

For example, someone has a PPO insurance. The average PPO’s premium is about $60 a month. The coverage has $50 deductible. Next, the insurance company pays a fixed percentage (pay ratio) according to the policy, and its upper limit is $1000. This insured one day needs a tooth and a root canal treatment and will have to spend a total of

* X-ray: $50 (payment rate: 100%, but deductible $50) = $50-$50 = $0
* Two teeth: $400 (pay ratio: 80%): $320
* Root canal: $800 (pay ratio: %50): $400
* Braces: $800 (pay ratio: %50): $400
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Total: $2,050, Insurance theoretically pays $1,120, but because the plan limit is $1000, someone still has to pay $2,050-$1,000 = $1,050 to the dentist.

Please note that the charge from the dentist to the insurance company is their negotiated rate. If you are self-insured, you probably would be charged higher rate. To take that into consideration, you should be able to make decision whether to have dental insurance is a smart thing to do or not.