FALLS CHURCH, Va. –
It isn’t always clear whether a condition involving your mouth is covered under a
TRICARE medical or
dental plan. Knowing which plan to use can help avoid unnecessary costs or delays in care.
“Your TRICARE medical plan may cover dental care if it’s due to an injury or medical condition,” said Doug Elsesser, Contracting Officer Representative, Active Duty Dental Program and TRICARE Dental Program, at the Defense Health Agency. “Knowing which plan to use can save you time and money.”
Here’s what to know.
What is the TRICARE Dental Program?
The
TDP is a separate, premium-based dental plan available to active duty family members, National Guard and Reserve members, and their family members. TDP covers services like:
- Checkups, sealants, and other preventive dental care
- Fillings and crowns
- Oral surgery and extractions
- Tooth implants
- Root canals
- Orthodontics, in some cases
You can find more details in the TRICARE Dental Program Handbook, which outlines coverage for restorative services and more.
When is dental care considered “medical”?
Your TRICARE medical plan may cover some conditions that require limited dental care, called
adjunctive dental care. Adjunctive dental care is treatment for a medical condition that causes a dental condition. A dentist may provide the care, but it’s considered medical for insurance purposes. On the other hand, the
TRICARE Dental Program covers routine and restorative dental work like cleanings or fillings.
Here are some examples of adjunctive dental care that TRICARE may cover:
- You break your jaw and a dentist removes a tooth to stabilize the fracture.
- You need surgery to treat cancer in or around your mouth.
- You were born with a condition in or around your mouth that affects your physical health.
Note: TRICARE requires pre-authorization for any adjunctive dental care unless it's a medical emergency. Your provider should submit a request before you receive care. Also, if you simply crack a tooth, TRICARE medical plans won’t cover treating it.
Coverage scenarios
When you need a dental procedure to treat a medical condition, it’s usually considered adjunctive care. This means it’s covered under your TRICARE medical plan, and not your dental plan. Here are some examples:
| Scenario |
Type of Coverage |
| Routine tooth cleaning or filling |
Dental |
| Root canal due to infection |
Dental |
| Braces for cosmetic reasons |
Dental |
| Wisdom Teeth Removal |
Dental |
| Tooth removal after facial trauma |
Medical—with pre-authorization |
| Surgery for a jaw fracture |
Medical—with pre-authorization |
| Removal of tooth fragments from soft tissue |
Medical—with pre-authorization |
Oral surgery and other procedures
Aside from fractures and other traumas, there are other procedures in and around the mouth that TRICARE medical plans cover. These are a few examples:
- Removal of tumors and cysts
- Treatment of oral and facial cancer
- Infection treatments around the mouth
- Surgery for sinuses, salivary glands, or ducts
- Surgical treatment of the temporal bone, the lower bone of the jaw, and the temporomandibular joint
- TRICARE doesn’t cover treatment of temporomandibular joint syndrome, sometimes called TMJ.
- Treatment of certain inherited conditions
For any of these procedures, contact your TRICARE health plan contractor about coverage and pre-authorization requirements.
Know before you go
Unsure which benefit to use? Speak to your TRICARE
health plan contractor or the TRICARE
dental contractor, United Concordia, before getting treatment.
Dental and medical care are both important to your overall health. Knowing which benefit to use gets you the care you need when you need it.
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