CHAMPVA is not a perfect health care program for everyone. One of the most regrettable as far as many beneficiaries are concerned, is its lack of comprehensive dental care benefits. While CHAMPVA does cover dental procedures in certain situations, most of the time it will not.
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Summary of CHAMPVA Dental Coverage
Generally, CHAMPVA covers only dental treatment that is considered adjunctive care. That is, the dental procedure must be a necessary adjunct to the treatment of a covered, medical non-dental condition. For example, to treat mouth cancer or a broken jaw, some dental work may need to be done first.
Routine dental care is specifically excluded in the CHAMPVA program. The only exception is when it is done to prepare for or because of dental problems caused by treatment of some illness or injury. Bridge work, dentures, implants, are not covered. Treatment of poor dental health is also excluded. Dental care that is preventive, routine, restorative, etc. are not covered unless as adjunctive ca
Oral surgeries are covered only if they are to treat a medical, rather than a dental, condition. The specific medical condition must also be covered by CHAMPVA, of course.
Examples of qualifying conditions are:
- Facial bone fractures
- Oral cancer
- Facial injuries (such as to the jaws, cheeks, mouth)
- Incision and drainage of cellulitis
All dental care must firs obtain pre-authorization. That is, you or the provider must first contact CHAMPVA to get approval for the procedure.
Dental Insurance and Dental Plans
As you can see, dental coverage under CHAMPVA is quite limited. Many people prefer to self-insure – that is, save money on their own – to get dental care when they need it. Others look for an affordable dental plan.
Private dental care insurance are sold by commercial health insurance companies. As such, you must pay a premium to buy such a policy. You can also look for dental plans, which are different from insurance although they may resemble each other.
Dental care in the United States can be very expensive when compared with treatment in certain other countries. Some veterans who travel and/or live abroad may prefer to have their dental needs addressed during foreign trips.
CHAMPVABenefits.com does not endorse a particular dental plan or insurance. It is advisable that you compare various plans to decide what best fits your needs and your budget.
UPDATE: The new VA Dental Health Insurance Program gives an opportunity to enrolled veterans and CHAMPVA beneficiaries a chance to buy dental insurance at reduced costs. the program opens for enrollment on November 15, 2013 with coverage beginning no sooner than January 1, 2014. Only veterans enrolled in the VA health care system and veterans’ dependents who are covered by CHAMPVA may participate. The VA has contracted with Delta Dental and MetLife for the 3-year pilot program.