Does Military Insurance Cover Braces For Dependents

The importance of oral health cannot be overstated, and for military families, accessing quality dental care can be a significant concern. When it comes to orthodontic treatment, such as braces, the cost can be prohibitively expensive for many families. Fortunately, military insurance may cover some or all of the costs associated with braces for dependents. In this article, we will delve into the specifics of military insurance coverage for orthodontic treatment, including the types of plans available, the eligibility requirements, and the process for obtaining coverage.

Military Insurance Covers Braces for Dependents

Understanding Military Insurance Plans

The United States military offers several health insurance plans to its active-duty personnel, retirees, and their dependents. The two primary plans are TRICARE Prime and TRICARE Extra. TRICARE Prime is a managed care plan that requires enrollees to receive care from a network of providers, while TRICARE Extra is a fee-for-service plan that allows enrollees to see any provider. Both plans offer comprehensive coverage, including dental care.

TRICARE Dental Program

The TRICARE Dental Program (TDP) is a separate plan that provides dental coverage to eligible beneficiaries. The TDP is administered by United Concordia Companies, Inc. and offers a range of benefits, including routine cleanings, fillings, and extractions. Orthodontic treatment, including braces, is also covered, but with some limitations.

Eligibility Requirements

To be eligible for TRICARE coverage, dependents must meet certain requirements. These include:

Being a dependent of an active-duty service member, retiree, or survivor
Being under the age of 23 (or 26 if enrolled in college)
Not having any other health insurance coverage

Additionally, to be eligible for orthodontic coverage, dependents must have a severe malocclusion, which is a condition that affects the alignment of the teeth and/or jaw.

Eligibility Requirements for Military Dependents

Coverage and Limitations

The TRICARE Dental Program covers orthodontic treatment, including braces, but with some limitations. The plan pays 50% of the allowed amount for orthodontic treatment, up to a maximum of $1,750 per dependent. However, if the treatment is deemed medically necessary, the plan may pay up to 80% of the allowed amount.

Medically Necessary Treatment

To be considered medically necessary, orthodontic treatment must meet certain criteria, including:

Severe malocclusion that affects the ability to chew or speak
Overcrowding that causes discomfort or pain
A significant impact on the patient's self-esteem or overall health

Process for Obtaining Coverage

To obtain coverage for orthodontic treatment, dependents must follow these steps:

Find a TRICARE-certified orthodontist: Dependents must see an orthodontist who is certified by TRICARE.
Get a referral: Dependents may need a referral from their primary care physician to see an orthodontist.
Submit a claim: The orthodontist must submit a claim to TRICARE for reimbursement.
Pay any out-of-pocket costs: Dependents may be responsible for paying any out-of-pocket costs, including copays and coinsurance.

Finding a TRICARE-Certified Orthodontist

Conclusion

In conclusion, military insurance may cover some or all of the costs associated with braces for dependents. The TRICARE Dental Program offers comprehensive coverage, including orthodontic treatment, but with some limitations. Dependents must meet certain eligibility requirements, including having a severe malocclusion, and must follow the process for obtaining coverage. By understanding the specifics of military insurance coverage for orthodontic treatment, dependents can access the care they need to achieve optimal oral health.