Several people have mentioned TRICARE Dental to me lately, both in online forums and in the workplace. Plus, I mentioned a few weeks ago that I was going to do a series on TRICARE. This is a continuation of that series. The first post is here if you’d like to check it out.
This is not meant to answer every question you have about TRICARE Dental. Instead, think of this as a place to start. I’ve compiled information from across the TRICARE site, then included some links to more information for the specific things you need. Enjoy! Well…enjoy as much as you can reading about dental care 😁
TRICARE Dental for Active Duty
Active Duty members use active duty dental care, meaning most dental care will come from a military dental clinic. This is the “easy answer” – you make your appointment, get seen, walk out the door. No money, no problems.
If for some reason you need to see a civilian dentist (a specialist, for instance), you would either receive care under the Active Duty Dental Program (if stationed in the US and US territories) or through International SOS (if stationed overseas).
Active Duty Dental Program (ADDP)
Not all dental procedures are covered under ADDP. Keep that in mind if you want non-covered services. You will be responsible for the payment. You can find a list of covered services starting on page 2 of this riveting document.
If you fall under ADDP and receive emergency care from a non-network provider, you may have to pay for the procedure. You will also have to pay for routine care if it exceeds the limit: $750 per procedure or $1,500 total within a consecutive 12-month period. You don’t have to get a referral, but you do have to contact United Concordia to receive an Appointment Control Number before you make the appointment.
Specialty care has the same monetary restrictions, but you also have to get prior authorization. This is a step beyond the Appointment Control Number that requires your civilian dental provider to fill out a request.
TRICARE Dental for Guard and Reserves
Guard and Reserve members have different dental care programs depending on their current military status. If you are not activated, you and your family can enroll in the TRICARE Dental Program. If you are activated for more than 30 consecutive days, you can use active duty dental care.
While enrolled in active duty care, you do not have to pay for TRICARE Dental Program. Additionally, your family’s enrollment will have lower monthly premiums. The website says this all happens automatically, but as an active duty member I’ve never actually experienced it. I’d love to hear from some Guard and Reserve members about how automatic it really is!
When you deactivate, you can either reenroll in TRICARE Dental Program, or, if you qualify for Transitional Assistance Management Program (TAMP), you will continue to have active duty benefits for 180 days. Once the 180 days ends, you can reenroll into TRICARE Dental Program. If you were previously enrolled, your coverage will resume automatically when TAMP ends. Your family’s rates will return to the pre-activation rates.
TRICARE Dental for Families
Like Guard and Reserve members, family members of servicemembers can enroll in the TRICARE Dental Program. The monthly premium cost will depend on a couple of factors, but something to note is that it’s not exactly a “per person” cost. Singles (meaning, one person who is not the military sponsor) pay one rate. There is also a family rate. The family rate is the group rate, not including the sponsor and not dependent on the number of people included. This means a spouse and one child cost the same amount as a spouse and five children.
TRICARE Dental Program
The TRICARE Dental Program is a voluntary dental plan administered by United Concordia.
TRICARE Dental Program offers coverage for most dental services, including 100% coverage for most preventive and diagnostic services. The complete Benefit Booklet can be found under the Related Downloads section here. It’s a download, so I can’t link directly to it – sorry!
The TRICARE Dental Program covers:
- Exams, cleanings, fluorides, sealants, and X-rays
- Fillings, including white fillings on back teeth
- Root canals
- Gum surgery
- Oral surgery and tooth extractions
- Crowns and dentures
- Orthodontics and braces
- Additional benefits for enrollees with chronic conditions and special needs*
- Additional cleaning for pregnant women*
*Must register the condition or special need
Premiums for the TRICARE Dental Program depend on the amount of people included and the sponsor’s status. For instance, a single person (not the military sponsor) whose sponsor is active duty pays $11.10/month for coverage. A Sponsor + Family plan for a non-mobilized Individual Ready Reservist would pay $99.94/month. Depending on your family size and needs, that may or may not be a good deal. The full breakout of premiums can be found here.
Keep in mind that the monthly premiums are not the full cost for care. Cost shares also apply for services. Additionally, the cost shares depend on the sponsor’s pay grade and where you live. You can find the full breakout of cost shares here.
TRICARE Dental for Retirees
The TRICARE Retiree Dental Program is another voluntary dental plan. Retired servicemembers, their family members, Medal of Honor recipients and family members, and survivors of the above can all enroll. It is available both in the US and overseas – awesome for those who want to live overseas after retirement!
Premium rates vary by location, but range from about $30/month for singles on the low end to $150/month for families of 3 or more on the high end. You can find your premiums here. Not yet retired? Use it to estimate your future costs!
Coverage in the Retiree program depends on the service given as well as the amount of time you’ve been enrolled. You can find the current coverage here. This page also covers the deductibles and maximums you’ll be expected to pay.