FALLS CHURCH, Va.   –   Do you or your child need braces? Do you wonder if the TRICARE Dental Program covers orthodontic care? Here’s what you need to know about getting straighter teeth through the TRICARE Dental Program.

“The benefits of having straight teeth aren’t just about aesthetics,” said Douglas Elsesser, dental program analyst, TRICARE Health Plan, at the Defense Health Agency. “Misaligned teeth can cause real oral health problems.”

Who gets orthodontic coverage?

The TDP covers orthodontic treatment for:

• All eligible spouses up to age 23
• Eligible children up to age 21 (or age 23 if they’re full-time students)

Remember to make sure you and your family members’ information in the Defense Enrollment Eligibility Reporting System is up to date. You can only get orthodontic care if your eligibility is reflected in DEERS.

What’s covered?

The TDP covers a variety of orthodontic services. These include:

• Diagnostic casts
• Certain appliances like braces
• Retainers

Costs

The TDP splits the cost with you. Here’s how it works:

• The TRICARE dental contractor, United Concordia, pays 50% of the allowable charge.
• You pay the other 50%.
• The lifetime maximum benefit is $1,750.

Your costs also depend on whether you use a network or non-network dentist. If you use a network dentist, you pay 50% of the TDP allowance. If you use a non-network dentist, you pay 50% of the allowance plus any amount over what TDP allows.

Get a pretreatment estimate

Ask your dentist for a pretreatment estimate before you start. This estimate shows:

• What United Concordia covers
• How much is covered
• When you make payments
• When United Concordia makes payments

Your orthodontist submits a treatment plan. Then you and your dentist each get a payment schedule from United Concordia.

How United Concordia makes payments

United Concordia bases payments on how long your treatment takes. The payment schedule shows when they send money to your dentist. Keep these points in mind:

• You must stay enrolled in TDP each month that United Concordia makes a payment.
• Total payments won’t go above the $1,750 lifetime maximum.
• If you turn 21 (or 23) during treatment, United Concordia calculates payments based on your eligible months.
• United Concordia sends a new schedule if your treatment plan changes.

Getting care overseas

You need a Non-Availability and Referral Form to get orthodontic services overseas. You can request this form from:

• Your TRICARE Area Office
• Overseas military dental clinic
• Designated OCONUS points of contact

You can get care from any licensed and authorized orthodontist. Visit United Concordia to find TRICARE OCONUS Preferred Dentists.

Dentists overseas may ask you to pay up front. If you use a TRICARE OCONUS Preferred Dentist, you only pay your cost-share portion, as described in the TRICARE Dental Program Handbook.

Learn more

For more details about your orthodontic benefit, check out United Concordia’s orthodontic coverage information.

Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions to get benefit updates, news, and more.