Whether you are a TDP member or not, you probably know that the TRICARE Dental Program offers coverage for diagnostic and preventive services as well as sealants, prosthodontics, orthodontics and oral and maxillofacial surgery. You may also know that the TDP program has recently transitioned to United Concordia, and you might have questions about the transition or about your eligibility for coverage under the new program.
Exclusion of benefit services performed in military dental care facilities
Considering that Medicare is a federally subsidized health insurance program, the exclusion of dental care facilities from the healthcare equation is something of a slap on the wrist. Although, a recent survey suggests that nearly a quarter of US adults suffer from dental pains on a regular basis. This, of course, leads to a spike in dental related claims and costs. A well informed and educated dental patient should know that a high quality and well coordinated dental care plan can be a lifesaver. Fortunately, such a plan is relatively easy to implement and maintain. The resulting savings are a boon to the health care consumer. The trick is finding the right dental care provider. The aforementioned perks and benefits may be available for individuals or their dependents, but not for all. For example, dental benefits may be available for children only. This enables parents to keep their kiddos happy without breaking the bank.
As for the actual cost of dental care, the HCFA estimates that the average annual cost for a family of four is $2,700. This figure is roughly matched by the estimated costs of dental care for the military. To get a better handle on this, an interested consumer should contact his or her congressional representative and find out for sure.
Cost-shares for non-network dental providers
Several types of dental benefit plans exist. Each has varying levels of detail. The amount of coinsurance and cost sharing required for specific services is one factor in choosing a plan.
Coinsurance means that you’ll pay a certain percentage of the cost of covered dental services. The most common coinsurance amount is 50%. However, there are plans that require less cost sharing for certain services. These plans often have lower monthly premiums.
Dental coverage plans can also impose a cap on the amount of money that you’re able to spend on dental services. In most plans, this limit is between $1,000 and $2,000 per year. The cap is more common in plans with more extensive benefits.
Many dental plans also have annual deductibles. The deductible is a fixed amount that you must pay each year. This deductible can range from $25 to $100. Usually, preventive care is not included in the deductible requirement. If you are unable to pay the deductible, you’ll have to pay for any non-covered services. This can be expensive.
Another common cost sharing element is a copayment, which is a fixed flat fee for dental office visits. Depending on the plan, these fees may be used to cover a larger portion of the service cost or they may not be covered at all.
Some plans also require that you use an in-network dental provider. If you choose to use a non-network dentist, you’ll have to pay a higher copayment.
Coverage for diagnostic and preventive services
TRICARE dental insurance plans offer a single plan for military members and their eligible family members. A comprehensive dental benefit package is offered through a network of participating providers. Comprehensive dental benefits cover a plethora of services from basic care to restorative and major services. These benefits are covered for the duration of the beneficiary’s life.
The Tricare Dental Program is administered by United Concordia and managed by Metropolitan Life Insurance Company. TRICARE dental insurance plans are available in the continental United States, as well as in OCONUS service areas. These plans are offered to members of the following categories: Active duty military; Reserve and National Guard members; and IRR family members. TRICARE dental insurance plans are also offered to spouses of service members. These plans are essential to military families.
The Tricare Dental Program is a voluntary insurance program. For active duty service members and their families, the program is one of the perks of being in the military. The program’s premiums will increase in the upcoming plan year. The plan is available in the following states: California, Connecticut, Florida, Georgia, Maine, Maryland, Massachusetts, New York, Oregon, Pennsylvania, Rhode Island, and Vermont. For more information on these plans, visit the Health Resources page. The plan also offers a SELF program, a health and wellness program for TRICARE members. This program is free to members and provides a variety of services and benefits to help members maintain a healthy lifestyle.
Coverage for sealants, prosthodontics, orthodontics and oral and maxillofacial surgery
Whether a dental service is included in a medical plan or not, the following guidelines are a good place to start. In general, the dental service must be medically necessary. Some plans require prior authorization for certain services, while others may require waiting periods.
The following services are not covered: extractions, dentures, root canal therapy, dental reconstruction, or non-removable prostheses. Some medical plans may cover medically necessary orthodontic services for children.
For members under 21, prior authorization is required for any medically necessary non-covered service. Members may also be required to submit a proposed treatment plan to Aetna’s Oral and Maxillacial Surgery Unit for review.
The following services are covered: basic services, including sealants, endodontics, and simple oral surgery; surgical removal of soft tissue impacted teeth; surgical removal of tumors; and surgical removal of erupted teeth. The following services are not covered: dental reconstruction, root planing, dental splinting, and tooth-colored fillings for back teeth.
Dental splinting is not listed in Subchapter 6 of the Dental Manual. However, dental splints may be covered under a specific contract.
Dental reconstruction is an oral surgical procedure that may be required after a jaw fracture. It is also needed to stabilize a dental prosthesis. It may include bone grafting.
Orthodontics is the branch of dentistry that treats malocclusion. It is necessary to have comprehensive orthodontic treatment, which may be completed in phases.
Beginning dates of eligibility for TDP benefits
TRICARE Dental Program (TDP) is a voluntary dental care benefit offered by the Department of Defense. It is administered by United Concordia Companies, Inc. It is available to active duty service members and their eligible dependents.
TDP’s most noteworthy benefit is a deductible reduction. The premium rates, as well as the amount of the deductible, change annually.
There are many ways to obtain TDP coverage. You can call the telephonic number, visit the website, and/or use the online application.
There are two types of TDP benefit plans. One type provides coverage for members of the Selected Reserve and their eligible dependents, while the other provides coverage to eligible National Guard and Reserve members’ spouses and children. The former requires a written election and the latter requires a telephonic election. The TDP is not obligated to make payment for services performed by a nonparticipating provider, though they may do so.
The TRICARE Dental Program is a high quality benefit available at a reasonable cost. The benefit year is from August 1 to July 31. During this period, the deductible reduction for each eligible family member is adjusted based on the number of days in the benefit year.
The TDP has other merits as well. For example, a TDP member’s spouse may qualify for a TDP Survivor Benefit. The TDP Survivor Benefit is not a direct payment, but an indirect reimbursement of up to 60 percent of the cost of the TDP premium. Similarly, the TDP has a unique and unusual way of tracking the cost of dental care for beneficiaries.
Transitioning from TDP to United Concordia
Changing your insurance provider is not a fun task for any member, let alone a member of the armed forces. Fortunately, UCCI was awarded a seven year contract to continue administering dental benefits for the TRICARE Active Duty Dental Program in 2021. As the largest dental insurance provider in the United States, UCCI will provide quality care to over 9.3 million active duty, reserve, and retired servicemembers and their families. Currently, UCCI operates in 23 service areas across the country, including Puerto Rico. With offices in major metropolitan areas around the country, UCCI is positioned to provide the services and products military members deserve.
United Concordia boasts a network of over 392,000 access points across the United States. The company is also well-versed in the latest technologies and trends in dental care, such as cloud-based digital imaging and diagnostics, and electronic medical records. Its impressive network of more than 125,000 dentists, orthodontists, and other hygienists is one of the largest in the industry. Aside from its impressive network of dental providers, the company also offers a number of other services and products to its subscribers, including network leasing and business solutions. UCCI also operates in the commercial sector, with over 22,000 clients. UCCI is a wholly owned subsidiary of Highmark Inc., a company that also happens to be one of the largest diversified financial services firms in the country.