FALLS CHURCH, Va.   –   When you need care for your mouth, jaw, or teeth, you may have questions about whether you should use your TRICARE medical or dental plan. Knowing when to use your medical or dental coverage helps avoid unnecessary costs or delays in care.

“When you need dental care because of an injury, it may be covered under your TRICARE medical plan,” said Douglas Elsesser, TRICARE Dental Program Analyst at the Defense Health Agency. “But this is only if it’s tied to a medical condition and pre-authorized. Knowing the difference can save you time and money.”

Here’s what you should know.

When is dental care considered “medical”?

In some cases, TRICARE medical coverage includes limited dental care known as adjunctive dental care. Adjunctive dental care is treatment you need to support a covered medical condition, injury, or disease. This is different from routine or restorative dental work. Routine and restorative dental work are covered separately under the TRICARE Dental Program, TRICARE Active Duty Dental Program, or other dental insurance.

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 remove tooth fragments embedded in your tongue after an accident.
• You need a restoration—like a crown or bridge—to replace a tooth lost during treatment of a medical condition.

Note: TRICARE requires pre-authorization for any adjunctive dental care unless it's a medical emergency. Make sure your provider submits a request before you receive care. However, if you simply crack your tooth, TRICARE medical plans won’t cover repairing or replacing it.

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. As described in the TRICARE Dental Program Handbook, it covers services like:

• Checkups and cleanings
• Fillings and crowns
• Oral surgery and tooth extractions
• Sealants and preventive care
• Orthodontics, in some cases

You can find more details in the TRICARE Dental Program Handbook, which outlines which restorative services are covered and which aren’t.

Note: TDP doesn’t cover adjunctive dental care. When you need a dental procedure to treat a medical condition, it falls under your TRICARE medical plan instead—but make sure to get pre-authorization.

Coverage scenarios

Generally, when the care supports a covered medical problem or injury, it qualifies as adjunctive dental care under medical. Otherwise, it falls under dental.

Scenario	Type of Coverage
Routine tooth cleaning or filling	Dental
Root canal due to infection	Dental
Braces for cosmetic reasons	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

Know before you go

Unsure which benefit to use? Speak to your TRICARE health plan contractor or the TRICARE dental contractor, United Concordia, to confirm coverage before getting treatment.

Dental and medical care are both important parts of your overall health. Knowing which benefit to use—and when—gets you the care you need with less hassle.

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