Orthodontics and crooked teeth
Orthodontics is the practice of fixing misaligned or crooked teeth. Using your dental health history, an exam, and X-rays, an orthodontist can determine if you’d benefit from orthodontics and a customized treatment plan.
Treatment usually involves placing dental appliances (such as braces, spacers, expanders, retainers and headgear) in the mouth to shift teeth. The TRICARE Dental Program provides orthodontic treatment for National Guard and Reserve sponsors and all spouses up to age 23. Children are covered to age 21 (or 23 if enrolled as a full-time student).
Why get treatment?
Properly aligned teeth and jaws are important to effectively eat and speak. Plus, usually you get a better-looking smile. This can do wonders for higher self-esteem and confidence.
Left untreated, crooked teeth can:
- Be harder to keep clean
- Be lost due to tooth decay and periodontal disease
- Cause muscle stress that can lead to headaches and other painful conditions
- Make you embarrassed about your appearance
Common orthodontic conditions
Here are some common conditions that may require orthodontic treatment. Only your dentist or orthodontist can make a proper diagnosis:
- Overbite: Upper front teeth stick out over the lower teeth
- Underbite: Lower teeth sit too far forward from upper teeth
- Crossbite: Upper teeth bite down awkwardly inside lower teeth
- Spacing: Gaps between the teeth when teeth don’t fill the mouth
- Crowding: Not enough room in the jaw to accommodate teeth
Children and orthodontics
Think your child’s teeth are at risk? Consult with an orthodontist before the first sign of a larger problem. It’s easier to adjust teeth in a younger, growing jaw than in a mature mouth that is more resistant to tooth movement.
The TRICARE Dental Program has you covered
The TDP covers 50 percent of United Concordia’s allowance, up to the Lifetime Orthodontic Maximum (OLM) of $1,750. The age limitations on orthodontic care are children up to age 21, or age 23 if the student is a full-time student; spouses up to age 23; and National Guard/Reserve sponsors up to age 23.
Payment example: A TDP network orthodontist charges an allowed fee of $4,000. The length of the treatment is 24 months and none of the orthodontic lifetime maximum (OLM) uwas used. The orthodontic payment would be calculated as follows:
United Concordia payment = $1,750.00
$4,000 x 50% cost-share= $2,000
Note: The enrollee has to pay the amount left unpaid by the TDP after applying the OLM. In this example, this is calculated as: $2,000 insurance cost share - $1,750.00 OLM = $250.
Beneficiary out-of-pocket cost = $2,250
$4,000 x 50% cost-share = $2,000 + $250 (amount remaining after application of OLM)
United Concordia’s installments to the dentist would be made as follows:
TDP contractor payment at initial banding
$1,750 x 25% = $437.50
24 monthly payments of $54.69 each
$1,312.50 divided by 24 =$54.69
Note: The TDP contractor still owes the amount of the OLM remaining after the initial payment, $1,750 - $437.50 = $1,312.50
Consult the TDP handbook for additional information on your orthodontic benefit