What's Covered | Your TRICARE Benefits
The following chart provides an overview of the TDP covered services and their respective cost-shares. TRICARE Dental benefits are the same for the CONUS service area as they are for the OCONUS service area.
Please note: The TDP provides selected services including endodontic, periodontic, and oral surgery at a reduced cost-share for enrollees who are grades E-1 to E-4. For more detailed information about the TDP covered services, see the TDP Handbook and the TDP Handbook supplement which contains covered codes and limitations.
|Annual Benefit Maximum||$1,500 per enrollee|
|Orthodontic Lifetime Maximum (See age limitations in Orthodontics Section below)||$1,750 per enrollee|
|Dental Accident Coverage Annual Maximum||$1,200 per enrollee|
|Covered Services||CONUS Service Area||OCONUS Service Area|
|Pay Grades |
E-1 - E-4
E-5 and above
|Consultation/Office Visit ||20%||20%||0%|
|Basic Restorative ||20%||20%||0%|
|Miscellaneous Services (occlusal guard, athletic mouth guard)||50%||50%||0%|
|Other Restorative ||50%||50%||50%|
- OCONUS cost shares only apply to command-sponsored enrollees receiving care in OCONUS service areas. These cost shares do not apply Selected Reserve (Sel Res) and Individual Ready Reserve (IRR) family members and IRR (other than special mobilization category) members. Beneficiaries in this category and/or non-command sponsored members are subject to CONUS cost-share arrangements as noted in the middle two columns above.
- Space maintainers for posterior teeth for patients under age 19 are fully covered.
- For questions about what is covered for dental emergencies, please refer to the TDP Dental Handbook.
- Orthodontic treatment is covered for the following enrolled family members:
- Children up to age 21 or 23, based on student status
- Spouses up to age 23
- National Guard/Reserve sponsors up to age 23
YOUR DENTAL PLAN INCLUDES TDP
Improved TRICARE Benefits for People With Certain Chronic and Medical Conditions
If you or an enrolled family member has been diagnosed with a chronic illness, is pregnant or has special needs, the TDP Wellness Program provides additional dental benefits at no cost to you. Getting the proper treatment and maintenance for gum disease will have a positive effect on your overall wellness as scientists continue to uncover connections between certain medical conditions and gum disease.
TDP Wellness Program is for people with the following chronic and medical conditions:
- Cerebral Vascular Disease (stroke)
- Coronary Artery Disease (heart)
- Oral Cancer
- Organ Transplant
- Rheumatoid Arthritis
- Pregnancy (additional, third cleaning in a consecutive 12-month period, only)
Register to use TDP Wellness Program any time after your insurance plan’s effective date. Here’s how:
- Sign into My Account using your DS Login
- Select Manage My Wellness
- Select Add your medical condition
With TDP Wellness Program you’ll get full coverage for periodontal services, including surgical procedures, to remove the financial obstacles to total oral care.
Improved TRICARE Benefits
|Periodontal maintenance – an additional service per year||100%*|
|Scaling and root planing||100%*|
|Periodontal surgery – four procedures**||100%*|
* Standard frequency limitations apply
** Four procedures related to gingival flap or osseous surgeries
The program also includes email outreach designed to educate and encourage you to stay on track with your oral care to better manage your condition. You can request to receive regular monthly emails full of tips to keep you aware of the importance of oral health.