Can I get dental under Tricare for Life?
April 2nd, 2012 | TriCare Help | Posted by Military Times
I am retired military. In the next few months I plan to retire from my full-time job with my local government, where I have dental insurance along with my other medical coverage. When I retire, all that coverage will cease. The only one I am concerned about continuing is the dental insurance: Does Tricare For Life offer dental insurance coverage for my wife and myself? If so, what is the monthly premium, and can it be deducted from my military retired pay?
Tricare dental benefits for military retirees have been provided under a contract with Delta Dental of California since 1998. The plan has a network of more than 100,000 civilian dentists and provides coverage under “basic” and “enhanced” plans in all 50 states, the District of Columbia, U.S. territories and Canada.
There is an annual deductible of $50 per person, up to a cap of $150 total per family. The annual maximum benefit is $1,200 for most covered services, Diagnostic and most preventive services don’t count toward deductibles and maximums.
Premiums are based on five pricing regions and the enrollee’s ZIP code, are adjusted each May 1. In Charleston, S.C., for example, the monthly premium for one person is $35.36, for two people $68.93, and for a family of three or more, $114.64. When you first enroll, you must prepay two months of premiums in advance. Initial enrollment is for 12 months, and then you have the option to continue on a month-to-month basis.
Not only can the monthly premium be deducted from your retired pay, but federal law actually requires such deductions for retirees.
You can find out much more about the program at its official website, www.trdp.org.
Can disabled adult son get Tricare and dental coverage?
February 3rd, 2012 | TriCare Help | Posted by Military Times
I am a retired, 100 percent disabled Navy officer. I have a 41-year-old son who is disabled and receives SSDI from Social Security. Does he qualify for Tricare and dental coverage?
To begin an inquiry concerning the possibility of your disabled son’s Tricare eligibility, please call the DEERS Support Office, toll-free at 1-800-538-9552.
If your son is determined to be entitled to Tricare, and if he is enrolled in free Medicare Part A, and in Medicare Part B, he will be entitled to the Tricare program called Tricare for Life. To use TFL, he must be properly registered in DEERS.
Under TFL, Medicare Parts A and B becomes the beneficiary’s primary health insurance, and Tricare Standard, as second payer, acts as a free Medicare supplement. The TFL beneficiary, thus, has coverage by two, full-service, stand-alone health “insurance” plans. The second plan, Tricare Standard, is provided without additional cost.
Under TFL, the vast majority of the beneficiary’s medical expenses will be paid in full by the combined coverage of Medicare plus Tricare. The only cost for Tricare for Life coverage is the monthly premium for Medicare Part B. That is somewhat more than $100 per month in 2012.
Tricare does not have a dental benefit. It does, however, provide for enrollment in a commercial dental insurance plan available to Tricare beneficiaries at group rates. There is a plan for active-duty personnel and their Tricare-eligible family members, and there is a similar plan for retirees and their families. You can get more information about the Tricare Retiree Dental Plan here.
Trouble getting surgery hospitalization covered
March 4th, 2010 | TriCare Help | Posted by Military Times
Q. My child needs dental surgery, and the procedure must be performed in a hospital. Tricare won’t cover the hospital portion – why? The dental insurance and Tricare are each saying the other needs to pay.
Your didn’t say how you learned that Tricare will not cover the hospital portion of your child’s dental care. Depending on whom you asked and the reasons you gave about why hospitalization will be needed, it is possible that you were misinformed.
If certain medical criteria are met, hospitalization for certain dental or oral surgery procedures can be covered for certain patients. Those rules are established by the federal regulation that governs Tricare.
If hospitalization is medically necessary and appropriate for the particular surgery your child needs, or if his medical condition is such that hospitalization is required for his safety, it can be covered by Tricare. That is a decision Tricare’s medical advisors will make based on medical information they receive from his physician and/or oral surgeon.
If Tricare has given you an official statement that the hospitalization will not be covered, I suggest you write to Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. Ask that office to reconsider its decision. A request for reconsideration is an appeal of an official decision. It requires Tricare to review the entire case to ensure that all the rules were followed correctly.
Include the name, address, and phone number of the oral surgeon. He, or your child’s physician, will need to explain exactly what is the surgical procedure to be done and the reason it must be done in a hospital rather than on an outpatient basis in the oral surgeon’s office or clinic. Tricare may want to speak with him about the case.
In your letter, you must state the specific matter that is dispute, and include copies of all correspondence you have had with the Dental Plan and with Tricare. Include the child’s full name, date of birth, your full name, and your Social Security number. Be sure to include a phone number where you can be reached during the day in case Tricare needs more information from you.
If all the business was transacted by telephone, please tell Tricare exactly whom (exactly which offices) you talked with and when. Include names of those you spoke with, if possible.
Covering dental work after an accident
December 1st, 2009 | TriCare Help | Posted by Military Times
Q. A friend fell off a ladder at work and broke off some teeth below the gum line. It took the dentist an hour to dig the roots out. Now Tricare won’t pay for it. I told him it’s because the bill is from a dentist, and Tricare won’t pay dentist bills. Was I right?
You might be right, but I haven’t seen your friend’s Tricare Explanation of Benefits form. An EOB is the statement you get from a health insurance plan that explains how it processed each of the charges on the claim.
If Tricare denied payment for all or part of the claim, the reason for the denial is reported on the Tricare EOB.
I think it may be more likely that your friend’s Tricare claim was denied because it resulted from a work injury. But there’s a way to find out, and perhaps to get payment.
Tell your friend he has 90 days to file an appeal of the denial. The appeal must be in writing and state the specific matter in dispute. It must be signed by the adult patient and include a copy of the EOB that reports the denied charges. He should send it to the address on the EOB.
If he has questions, advise him to call his Tricare Service center. He can get that number by calling the Defense Enrollment Eligibility Reporting System office toll-free at (800) 538-9552.
What about dental?
October 20th, 2009 | TriCare Help | Posted by Military Times
Q. Are there any dental benefits for military retirees?
Tricare has arranged for a commercial dental program available at special group rates for uniformed service retirees. Most beneficiaries who subscribe say it is quite good, and cheaper than plans available for civilians. You can get more information about it here.