TRICARE: Orthognathic Surgery

Autumn94

New Member
Registered Member
I’m struggling hardcore to find out whether or not I’m covered after I’m retired.

Long story short: I’ve been in braces through the US Army dental program here at Fort Gordon, GA. The dental clinic ONLY sees Active Duty personnel. I’ve been their patient for 3 and a half years and have been gearing up for the orthognathic double jaw surgery to correct my gnarly overbite. This treatment plan has been in the works for years, but unfortunately, due to the MEB, I’m unable to complete treatment while I’m still AD.

I’m currently being boarded for PTSD, and from what I’ve been told by my providers and Air Force side of things, I’ll likely be rated at or above 50% DoD. Obviously I know it’s not guaranteed, but comparatively, they’re confident I WILL be medically retired and will be covered by TRICARE once I’m out.

I plan on purchasing PRIME as soon as I’m out so that there’s no lapse in medical coverage.

My issue is that no one can tell me if I’ll be liable to pay for this oral surgery (which according to TRICARE is not considered dental care). I was instructed by my oral surgeon team on base to go ahead and meet with an off-base orthodontist and ask for a referral for oral surgery. But then the team was unsure if I’d have to pay for it regardless of the referral.

I told them “But I’ll likely be retired; if that’s the case, would I still have to pay? I’m going to still be in DEERS.” And they said “...we’ll try to work something out.”

Am I missing something? Don’t retirees with PRIME have the same coverage as active duty? This has been in my care plan for YEARS. It’s been medically necessary/required since I started seeing my oral team.

Who do I need to talk to? Am I freaking out for nothing? Please help. I’m losing my mind over this, and can’t afford to pay $35,000 for oral surgery and follow up care.
 

You have to sign up for FEDVIP for both dental and eye if you want, you can get cheap coverage or premium and you pay monthly for it. I picked united concordia as they provide unlimited coverage (most have a maximum annual cap) you still have a co pay usually 20% so that would be 7G for you. The only way for it to be free is if your service connected for dental or 100% T&P rated. Orthodontic work is typically not considered a necessity and make sure you read what ortho work is covered some plans offer none most only a one lifetime allowance. DO NOT sign up for any insurance with a waiting period.

For Prime you have to be in a prime area to be covered otherwise you are in select, select is free and you only pay out your deductible and co pay when needed.
 
Often DENTAC will continue services to retirees on a “space available” basis if it provides a benefit to the organization. Have a talk with the commander.

FWIW DENTAC did four dental implants for my wife which were barely covered by Tricare. The commander even managed to get the abutments and crowns donated from the vendor ($12K was the cost) The only benefit to DENTAC was the training experience.
 
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