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Dental Care: What Retirees Get and Don't Get from TRICARE

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 21, 1999, Sept. 21, 1999 – More than 470,000 military retirees and eligible family members have enrolled in the TRICARE Retiree Dental Program since its inception in 1998. Many of those enrolled, however -- and many who are undecided about enrolling -- don't fully understand how the plan works, program administrators said.

The most common misconception is that the retiree plan is the same as the plan for active duty families, according to Dr. Lowell Daun, senior vice president and general manager of the Federal Services Division Delta Dental Plan of California, the private contractor DoD selected to run the plan. In fact, he said, the program is not like either typical employer-funded programs or the TRICARE Active Duty Family Members Dental Program.

What the plan offers is affordable diagnostic, preventive and basic restorative services and the freedom to choose your own dentist, Daun said.

"It's important to understand, however, that other services are only partly covered and a few are not covered at all," Daun said. Crowns and bridges, for example, aren't covered benefits.

Delta doesn't cover crowns and bridges because to do would violate DoD regulations aimed at limiting the program's cost, Daun said. The retiree dental plan was created with the idea of keeping costs for retirees and their family members to a minimum, without the government subsidizing the program. DoD called for a basic, economical program to defray some of the cost of dental care, while promoting early diagnosis and prevention of dental disease.

"Bridges, cast crowns and dentures were specifically excluded, while excellent coverage for basic diagnostic and restorative procedures, emergency care, oral surgery and periodontal services was included," Daun said.

Enrollees may use any licensed dentist they choose for care under this program. However, Delta has an agreement with 24,000 "DeltaSelect USA" dentists to serve this program, and enrollees may save money by using a network provider.

Enrollment averages about $13 a month per person, with the first four months' premiums due when you sign up. The Defense Finance and Accounting Office automatically withdraws the premiums from military retired pay. What some enrollees may not understand, however, is that they incur a two-year commitment to the plan when they sign up. DoD included the minimum enrollment requirement to make sure members reach what Daun called "dental maintenance."

"This term refers to improving the status of a dental plan member's oral health to the point where regular cleanings and exams will effectively maintain healthy teeth and the supporting gum tissue," Daun said. "Experience shows that a mandatory [minimum] enrollment period is necessary to ensure that those with overwhelming dental needs won't leave the program once their most immediate (and expensive) needs are met. A voluntary dental program is simply not financially sustainable under such conditions."

Daun said the TRICARE Retiree Dental Program is more competitive than other plans available through private insurers. "The power of the uniformed services retiree population as a group enables Delta to offer a program that complies with federal regulations, increases the affordability of dental care and motivates retirees to seek care before expensive and painful dental problems occur," he said.

Delta provides answers to the most frequently asked questions at its Web site, www.ddpdelta.org and through its customer service office at (888) 336-3260. You also can enroll online. In addition, Delta sends detailed information packets to new enrollees. Just one of the tools available at the Web site is the benefits chart below:

 

Covered Services DELTA PAYS YOU PAY
Diagnostic/Preventive Services: [Includes exams, x-rays, cleanings and fluoride treatments] [No deductible or maximum] 100% 0%
Basic and Restorative Services: [Includes sealants and space maintainers for children's teeth, fillings and prefabricated crowns] [Deductible and maximum apply] 80% 20%
Drugs, Endodontic, Periodontic and Oral Surgery Services: [Includes therapeutic drug injections, root canals, gum tissue surgery, deep root cleaning, extractions, sutures and treatment of post-surgical complications] [Deductible and maximum apply] 60% 40%
Emergency Services: DELTA PAYS YOU PAY
Emergency oral examination 100% 0%
Minor treatment for dental pain [Deductible and maximum apply] 80% 20%
Note: Annual Deductible: $50/person; Annual Maximum Benefit: $1,000/person

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