When you marry into the military -- or your spouse joins the military -- you learn a whole new benefits system to go with your new lifestyle. At the top of the list is the military health care system, Tricare, and the Tricare Dental Program.
Does Tricare cover dental?
Just like most private employers, dental insurance or dental coverage is separate from normal medical coverage. And unlike Tricare's medical coverage, which is automatic for every military dependent, Tricare's dental coverage requires special enrollment.
How do I get Tricare Dental coverage?
Currently, the Tricare Dental Program (TDP) for active-duty family members and Guard and Reserve members and their families is administered by United Concordia. (There is no Tricare Dental Program for retirees. They instead use the FEDVIP system.)
Your sponsor can enroll you into TDP by logging into their Beneficiary Web Enrollment website. The minimum enrollment period is 12 months and can then be continued on a month-to-month basis. The service member can only enroll a dependent if they have at least 12 months left on their service contract.
There are two plan options, single or family. The "single" plan covers one person, which can be one active-duty family member, one National Guard or Reserve sponsor or one National Guard or Reserve family member. The "family" plan enrolls everyone registered in DEERS as a military dependent. If you choose the family plan, all family members over the age of 1 must enroll. Children younger than 1 will be automatically enrolled after their first birthday.
If you have family members at multiple locations, they are not required to enroll. Also, if you have family members with a documented need for special medical attention in a hospital or treatment center, they can be exempt from this enrollment. To use these exemptions, you'll need to contact United Concordia directly at 1-844-653-4061. (The OCONUS toll-free number is 1-844-653-4060.)
When does Tricare Dental coverage start?
It's important to note that Tricare dental coverage does not start automatically upon enrollment. If you enroll before the 20th of the current month, your coverage will start on the first day of the next month. If enrollment happens after the 20th, you'll have to wait a full month after that for your coverage to begin on the first day of the second month.
How much does Tricare Dental cost?
Tricare's dental coverage has an out-of-pocket monthly fee no matter who is using it. For single dependent coverage when the sponsor is on active duty, the 2022-2023 cost is $11.94 a month, and for family coverage, it is $31.04. For others eligible, the premiums vary depending on status.
The first month's coverage is due at the time of enrollment and the rest of the payments can be made through allotment or an electronic fund transfer. It's important to note that if your payment doesn't process, you'll lose your coverage and be unable to re-enroll for a year.
What does Tricare Dental cover?
The Tricare Dental Program is not all-inclusive. The maximums are $1,500 per person, per contract year, with an annual maximum for accident care of $1,200 per person, per year. There is a lifetime maximum of $1,750 per person for orthodontic treatment.
“Maximum coverage” means $1,500 is the most the Tricare Dental Program will pay for your care each year. What is charged, known as an “allowed fee,” by dentists is set by contract between the dental office and United Concordia and is based on location. How much you pay out of pocket -- known as “cost share” -- is set by the TDP.
For example, the cost share in CONUS for oral surgery is 30% for paygrades E-4 and below and 40% for E-5 and above. If the allowed fee for oral surgery is $500 and your sponsor is an E-4, you’ll pay a cost share out of pocket of $150, while the remaining $350 will be paid by the dental plan and will count toward your annual maximum coverage.
Some services do not count toward that annual out-of-pocket max and do not carry any cost share fees. For example, semi-annual cleanings carry no fees and do not count toward your maximum coverage cap.
For a complete breakdown of costs, go here.
Does Tricare Dental cover braces for spouses and kids?
Orthodontic treatments can be really expensive, and the Tricare Dental Program does offer some help.
Orthodontic coverage is covered separately from your other maximum. Instead of an annual max, it has a lifetime maximum coverage of $1,750 per person. For orthodontics, you’ll pay 50% out of pocket, with the other half covered by the plan.
On the cost-share chart, orthodontic care is listed as 50% across the board, with 50% covered up to the lifetime maximum of $1,750 per person.
But not everyone is eligible for that coverage. Children up to age 21 or 23 can access it, while spouses and National Guard or Reserve members must be 23 or under. Also, any costs above and beyond the lifetime maximum must be paid out of pocket.
How do I pick a Tricare dentist?
Choosing a dentist is slightly different than choosing a primary care manager through Tricare, especially if you're used to using Tricare Prime.
You can choose any dentist you want that accepts United Concordia. You can travel as far as you want, and can even pick one dentist for you and a special pediatric dentist for your kids. Don’t be surprised if finding a pediatric dentist is a little difficult, though. When United Concordia took over the contract, dentists across the country chose not to remain in-network because of the lower reimbursement amounts allowed.
While United Concordia has an obligation to make sure 95% of enrollees have a general dentist within 35 miles of their residence that has an opening for an appointment within 21 days, that does not include pediatric dentists, who are considered specialty providers.
If the dentist you want is not available, there is another option. You can see an out-of-network dentist. Seeing a dentist out of network may mean you pay for your entire visit upfront. And, if the amount United Concordia pays the dentist isn't the full amount due, you'll be responsible for paying that part as well.
To find a list of providers in your area, you can check the Tricare website. But the best option is could be a combination of that and asking your local spouse group on Facebook for recommendations.
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