Does Tricare Cover Braces for Active Duty Military?
As an active duty military member, you have a range of benefits provided to you through Tricare, the military’s healthcare insurance program. One common concern for many military families is whether Tricare covers dental care, including braces, for their dependents. In this article, we’ll dive into the details and explore the answer to this question.
Does Tricare Cover Braces for Active Duty Military?
Yes, Tricare covers some types of orthodontic care, including braces, for active duty military dependents. However, it’s essential to understand that there are specific guidelines, limitations, and exceptions.
Eligibility Requirements
To be eligible for Tricare coverage of braces, your dependent child or spouse must meet the following requirements:
- Be between the ages of 0 and 21 (including 21)
- Not be eligible for TRICARE Young Adult (for dependents over 21)
- Have a referral from a primary care manager (PCM)
- Require orthodontic care to correct a developmental defect, injury, or condition, such as crooked teeth, overbite, or underbite
Tricare Coverage Levels
Tricare offers different coverage levels, which affect the types of services and expenses you’ll need to pay. Here’s a breakdown:
| Coverage Level | Eligible Beneficiaries | Orthodontic Coverage |
|---|---|---|
| Prime | Active duty military dependents | Fully Covered |
| Select | Some active duty military dependents, retirees, and retired dependents | Up to 80% Coinsurance |
| Expanded | Some active duty military dependents, retirees, and retired dependents | Up to 60% Coinsurance |
| Standard | All beneficiaries, including civilians and individuals with TRICARE Supplement | Up to 50% Coinsurance |
Coverage Limits
Tricare has coverage limits for orthodontic services, including braces. For dependents with a PCS (Permanent Change of Station) or an FCL (Family Care Leave) authorization, Tricare typically covers:
- 8-12 months of treatment for children under 7 years old
- 12-24 months of treatment for children 7-12 years old
- 24 months of treatment for children over 12 years old
Out-of-Pocket Costs
Even with Tricare coverage, you’ll likely need to pay some out-of-pocket costs for braces. Here are some examples:
- Co-Payment: A flat fee for each orthodontic visit, usually ranging from $10 to $50.
- Co-Insurance: A percentage of the total orthodontic bill, ranging from 10% to 60% depending on your Tricare coverage level.
- Deductible: An annual fee that applies to all medical expenses, including orthodontic services.
Pre-Authorizations and Referrals
Before starting orthodontic treatment, you’ll need to obtain a pre-authorization from your Tricare provider. This ensures that your dependent meets the coverage requirements and that the orthodontist’s services are deemed medically necessary.
A referral from a primary care manager (PCM) may also be required, but this varies depending on the orthodontist and Tricare’s specific requirements.
Conclusion
In conclusion, Tricare does cover braces for active duty military dependents, but the coverage is subject to eligibility requirements, coverage levels, and limits. Understanding your Tricare coverage level and the specific guidelines for orthodontic care can help you navigate the process more effectively.
Here’s a summary of the key takeaways:
- Tricare covers braces for dependents under 21: With a referral from a primary care manager (PCM) and meeting eligibility requirements.
- Coverage levels: Prime, Select, Expanded, and Standard have different coinsurance rates for orthodontic services.
- Coverage limits: Orthodontic services are usually covered for 8-24 months, depending on age and PCS/FCL status.
- Out-of-pocket costs: Co-payment, co-insurance, and deductible fees may apply.
By understanding your Tricare coverage and following the necessary steps, you can get the orthodontic care your dependent needs. Always consult with your orthodontist and Tricare provider to ensure you’re eligible for coverage and to confirm any specific requirements.
