The TRICARE Dental Program (TDP) offers 100% coverage for emergency, diagnostic and preventive services. It covers crowns, bridges, dentures, fillings, root canals, tooth extractions and orthodontics with a member cost share. The plan also provides periodontics, sealants and restorative procedures for temporomandibular joint disorders, such as TMD, at 100% with no co-pays. It also covers 80% of the allowed fee for dental implants, although there is a 20% co-payment by the beneficiary. TDP also offers dental appliances, such as mouthguards and gum surgery, at 50% to 80%.
TDP is available to active duty family members and National Guard and Reserve families through military dental clinics or private providers that have agreed to accept TDP. It is not available to retired service members, spouses of retiring or deceased active duty military personnel and their family members, and children over age 23 who are no longer eligible for active duty coverage. It is also not available to individuals with less than 12 months left on their active duty commitment, except in certain special circumstances.
Monthly premium rates are based on an individual’s military status, location and family size. The current TDP annual maximum and lifetime orthodontia max is $1,750 per person. The TDP deductible is $50. It is important to note that the annual maximum and orthodontia max are separate maximums, meaning that they do not apply to each other.
Eligibility
To be eligible to enroll in TRICARE, an individual must have at least twelve months remaining on their service commitment or be a current National Guard or Reserve sponsor or family member. Those who have already completed their service obligation may enroll in the plan under certain special circumstances. Once enrolled, individuals can visit the TRICARE Find a Doctor website to locate dental providers that accept their coverage.
Veneers are generally considered to be cosmetic procedures and are therefore not covered by most insurance plans. This is because they primarily address aesthetics rather than functionality. While some cosmetic treatments have functional benefits, such as treating a tooth misalignment, veneers focus solely on improving appearance.
If you are considering veneers, consult with your dentist and TRICARE to understand the cost-sharing requirements for your specific case. Alternative options such as private dental insurance, flexible spending or health savings accounts and payment plans or financing can help make the treatment more affordable.
Enrollment
TRICARE Dental coverage is separate from TRICARE’s medical coverage and requires special enrollment. Enrollment is done through the TRICARE Dental Program (TDP). TDP is a voluntary program administered by United Concordia Companies, Inc. It is available to active duty family members, National Guard and Reserve sponsors, and their dependents. The TDP brochure has more information on coverage and costs.
Active duty sponsors and their families can receive dental care at military treatment facilities, known as MTFs. Those deployed overseas have access to care at host-nation dental clinics, which may offer reduced fees or free services. Those who do not live near an MTF can see a network dentist for a nominal fee. The TRICARE Dental Program also provides care to those whose service members are killed in action, and surviving family members have three years of premium-free TDP coverage.
When retirees leave the military, they are eligible to purchase a FEDVIP dental plan for themselves and their dependents through the Federal Employees Dental and Vision Insurance Program (FEDVIP). Under Section 715 of the FY 2017 National Defense Authorization Act, Public Law 114-38, FEDVIP became an enrollee-pay-all program. It is available to Federal and Postal employees, retirees, and their eligible family members, with premiums deducted on a pre-tax basis from their paychecks. Retirees can choose a FEDVIP plan during the Federal Benefits Open Season, which runs from November through midnight Eastern time on December 10. They can also change plans during the annual period following a qualifying life event such as a move, marriage, birth of a child, etc.
How Do I Know If My TRICARE Covers Dental?
TRICARE Dental is a separate voluntary program that costs extra to enroll in. You can get information about the program on the Beneficiary Web Enrollment website. To enroll, you need a Common Access Card (CAC), DFAS (MyPay) Account, or DoD Self-Service Logon (DS Logon).
You can see any dentist, but the coverage is based on the Delta Dental allowed rates. This means that if the non-network dentist charges more than the plan’s authorized amount, you have to pay the difference.
The maximums are $1,500 per contract year for dental care and an annual maximum of $1,200 for accident care. There’s also a lifetime maximum for orthodontic care of $1,750 per person.
This brochure covers eligibility and enrollment; information for the National Guard and Reserve; choosing a dentist; fees, costs, and benefits; accessing dental care; claiming dental services; filing claims; traveling and moving; and appeals, grievances, fraud, and abuse. Stateside and overseas contact information is included.
Your TRICARE dental coverage goes on hold if you go on active duty. But you can enroll in the TRICARE Dental Program if you get called back to active duty and have more than 12 months on your service commitment. To do so, you must fill out a new TDP Enrollment/Change Authorization Form. You can find forms online or in the TDP book.