Dental insurance for undocumented – Everyone should take care of their teeth. The Mayo Clinic calls them a “window into your overall health.” Dental insurance can be a key component to your dental health.
If you are undocumented or a non-US citizen here in the United States, you may think that you cannot buy dental insurance. It is not like this. Dental insurance is available to non-US citizens, including undocumented immigrants and those without a social security number. In this article, we discuss the basics of dental insurance and the types of dental insurance for non-US citizens.
Basic concepts of dental insurance for undocumented immigrants
Below you will find important definitions that make it easier to understand dental insurance.
- Annual Benefit – The amount the company pays each calendar year on your behalf for services. Think of it like a bucket of money. This money pays the dentist for the company’s share of services. It is based on the cost of the contracted insurance, not on what the dentist can charge someone who comes from the street.
- premium : what is paid each month for insurance
- Deductible – What you pay first before the dental plan pays. Most deductibles are between $50 and $100; however, there are some for $0.
- Preventive Services – Consists of cleanings, office visit, and x-rays. If you go to a network dentist (below), the plan usually covers 100% of the cost.
- Basic Services – Consists of fillings and extractions. Some companies also include X-rays here.
- Major Services : Consists of crowns, root canals, dentures, etc.
- waiting period : period of time before using the services. Most plans have immediate coverage for preventive services, 6 months for basic services, and 12 months for major services. If the work is done during this waiting period, the insurance does not cover it.
- In-Network Dentists vs. Out-of-Network Dentists – This is an important component to understand. Network dentists contract directly with the insurer. They agree with the prices of your insurance. Out-of-network dentists do not accept insurance prices. Instead, they may balance bill you.
- Balance Billing – This is an out-of-network dentist’s practice that bills you for the difference between your price for a procedure and the insurance company’s payment.
These are some of the basic aspects of dental insurance that we expose in the article.
The importance of a network dentist
It is important that you use a network dentist whenever possible. The reason is that the company requires the dentist to charge you the insurance fee . Suppose your dentist’s “retail” price is $100 for a filling. It’s in your dental insurance network. The cost of the filling for insurance is $25. If the insurance company pays 80% of the filling and you pay 20%, that means you only pay $5. It’s much better than paying $100!
If you go to an out-of-network dentist, you will have to pay balanced billing (described above) and a UCR fee. UCR stands for Usual, Customary and Reasonable. This refers to how dentists in your area charge for a certain procedure. The insurance company looks at the UCR rates for your area and bases its cost share or reimbursement on this rate. UCR typically applies to out-of-network coverage and indemnity plans.
Example of in-network and out-of-network rates and UCR
You’ll want to go to an in-network dentist, as in-network insurance coverage often has better contracted rates. We’ll show an example of that in a minute.
The insurance covers cleanings or preventive care at 100% . Basic and main services are usually covered at 80% and 50%, respectively. What does this mean? That if you go to an in-network dentist for a filling (80%) at a contracted rate of $100, you will have to pay $20 out of pocket ($200 X (1 – 0.80)). The company pays the dentist $80.
If you go to an out-of-network dentist, the plan usually pays based on the UCR rate. For example, if the dentist charges $250 for the filling, but the UCR in his area is $150, he could end up paying more. In this case, $130: ($250 – $150 X (.80)). The company still pays 80%, but 80% of $150, not $100.
This also introduces the concept of balanced billing, which, as defined above, means paying the dentist the difference in cost between his “retail” fee ($250 in this case) and the cost-sharing insurance fee ($120).
Therefore, most of the time it is more advantageous to go to a network dentist.
Types of dental insurance for non-US citizens
There are actually three types of dental insurance for non-US citizens. They have many similar attributes, but also differences that we describe throughout this article. The right dental insurance depends on the status of the non-US citizen. Next, we will talk about it.
The three types of dental insurance are
- traditional dental insurance, with in-network and out-of-network coverage, cost sharing, deductible and copays. Traditional insurance can be an in-network plan or both in-network and out-of-network (PPO).
- Indemnity insurance plans that will pay a benefit directly to you or the dentist. It usually doesn’t matter which dentist you go to. These plans pay a fixed benefit or percentage of benefit regardless of what the dentist charges. They are useful if your dentist does not accept insurance and you want to have some coverage.
- Discount dental plans, in which you pay out-of-pocket expenses at a discount on the dentist’s fee, according to a contracted scale.
Non-U.S. Citizen Indemnity Dental Insurance
These plans pay a fixed dollar benefit regardless of what the dentist charges. In other words, you can go to any dentist and receive a benefit. These plans make sense when the dentist you see does not accept insurance.
Will you have to pay the balance of the bill? Perhaps. Maybe not. Since these plans do not require a dentist, it is not necessary to inform the dentist of the insurance. You can simply negotiate the cash price with the dentist and then file the claim directly with the company. For example, let’s reuse the filling example. The dentist’s retail price is $150, but you negotiate at $100 and pay $100 out of pocket. You then file a claim with the company. The company pays 80% of the UCR fee. The UCR fee is $80. The carrier pays you $64 (80% of the UCR). Your net expense in this case is $36 ($100 what you paid minus $64 what you received).
Let’s say the UCR was $150. You would receive 120 dollars. The net profit is $20. Does this always happen? No, but it can happen. You will most likely have to pay a net out of pocket.ou
These plans make sense for undocumented immigrants and those without a social security number.