TRICARE Orthodontic Coverage
As anyone who has been recommended braces by a dentist knows, orthodontic work can be expensive, particularly when treatment stretches over years. For enrollees in the TRICARE Dental Program (TDP), orthodontic coverage can help with some of those costs, but you should understand its age limits and cost-sharing requirements before beginning treatment. Here’s what you need to know before starting orthodontic care through TDP.
TRICARE Orthodontic Coverage
Military families use TRICARE, and for dental coverage they pay to use the TRICARE Dental program. Administered by United Concordia, this voluntary dental plan is available to eligible active-duty family members, National Guard and Reserve families, and certain non-activated Guard and Reserve members.
Active-duty service members receive dental coverage separately through military dental clinics or the Active Duty Dental Program.
TDP requires a monthly premium and generally has a minimum 12-month enrollment period. For National Guard and Reserve members, there’s another consideration. TRICARE advises sponsors to check with their unit commander before getting braces because orthodontic treatment can potentially affect eligibility for certain assignments.
The program covers preventive and routine dental care as well as services such as fillings, oral surgery, dental implants, dentures, and orthodontic treatment. Costs vary based on the sponsor’s status, the type of treatment, and whether the patient uses a network dentist. Families in the continental U.S. can use any licensed and authorized dentist, although using a United Concordia network provider can reduce out-of-pocket costs and paperwork.
Overseas, patients may have to pay for covered services up front and seek reimbursement. TRICARE OCONUS (outside of the continental U.S.) Preferred Dentists generally file claims directly and charge patients only their applicable cost-share at the time of treatment.
What Are the Eligibility Requirements for TRICARE Dental?
Under current TDP rules, orthodontic treatment is covered for eligible spouses under age 23 and children under age 21. Children who are full-time students remain eligible until age 23. National Guard and Reserve sponsors may also qualify for orthodontic coverage through age 23, and if they aren’t on active-duty orders for more than 30 days, they may also enroll.
To qualify, service members must have at least 12 months remaining on their service commitment, and the family’s information in DEERS must be current, since incorrect or missing info can delay or prevent enrollment.
Active-duty service members (including Guard and Reserve members) activated for more than 30 consecutive days aren’t eligible for TDP because they receive dental coverage separately.
TDP also doesn’t cover retired service members and their families, former spouses, parents and parents-in-law, disabled veterans, foreign military personnel, or service members covered by the Transitional Assistance Management Program following activation for a contingency operation.
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What Orthodontic Services Does TDP Cover?
Benefits include diagnostic casts and orthodontic appliances such as braces and retainers. Clear aligners can also qualify for coverage and are generally covered under the same benefit as conventional braces.
United Concordia pays 50% of the allowable charge, subject to the plan’s lifetime maximum.. Diagnostic services are applied to the separate annual dental maximum rather than the orthodontic lifetime amount.
The type of provider you choose can also affect what you pay. With a network dentist, you generally pay 50 percent of the TDP allowance. If you choose a non-network provider, you’re responsible for that cost-share and any charges above the amount TDP allows.
Since a full course of orthodontic treatment can cost considerably more than the TDP lifetime benefit, families shouldn’t assume that “covered” means their out-of-pocket expenses will be limited to the allowance or that TDP will pay half of the entire bill.
Should You Get an Estimate Before Starting Treatment?
TRICARE recommends requesting a pretreatment estimate before starting orthodontic care. Your orthodontist submits the proposed treatment plan to United Concordia, and you and the provider receive information explaining what the plan will cover, how much it will pay, and when payments will be made.
For treatment in the continental United States, United Concordia bases its payments on the expected length of treatment. You must remain enrolled in TDP each month United Concordia makes a payment. Total TDP payments can’t exceed the orthodontic lifetime maximum. See the United Concordia official site for the most current lifetime maximum.
Age can matter once treatment is underway, too. If a patient reaches the applicable age limit during treatment, United Concordia calculates payments based on the months the person remains eligible. If the treatment plan changes in a way that affects payments, it issues an updated payment schedule.
What Should Military Families Know About Orthodontic Care Overseas?
Orthodontic care gets a little more complicated for families stationed outside the continental U.S. Before receiving covered orthodontic treatment overseas, you must obtain a Non-Availability and Referral Form (NARF).
Depending on your location, you can request the form through an overseas military dental clinic, TRICARE Area Office, or designated OCONUS point of contact. Once the required authorization is in place, you can receive treatment from a licensed and authorized orthodontist.
Military dental clinics overseas may also provide some care to family members when space is available, but the services available vary by location. Families should check with the dental clinic at their particular installation rather than assume orthodontic treatment will be available on base.
How Does Overseas Orthodontic Payment Work?
Overseas dentists may require patients to pay the full cost of covered services up front, then seek reimbursement.
Instead of making payments throughout treatment, as it generally does for care in the U.S., United Concordia can make a lump-sum payment for approved overseas orthodontic treatment once the treatment plan has been approved. The family is responsible for the portion United Concordia doesn’t cover.
However, that lump-sum system creates something families should consider carefully before beginning treatment overseas: it can use the patient’s entire orthodontic lifetime maximum at once. If that happens, TDP won’t have additional orthodontic benefits available for later treatment. This can become especially important if your family receives PCS orders before the braces come off.
The reverse situation also requires planning. If you’re moving to an overseas duty station from the U.S. while treatment is already underway, you’ll need a NARF before transferring to an OCONUS orthodontist. TDP’s overseas lump-sum payment will then be based on whatever remains of the patient’s orthodontic lifetime maximum.
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