10 Things VA Dental Insurance Doesn’t Cover Benzinga

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Some or all of your dental care needs may be met by the Veterans Administration (VA) if you qualify for VA dental benefits. Even if you don’t qualify for comprehensive dental care through the VA, military retirees have other options, including coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP). administered by BENEFEDS or through the Delta Dental Veterans Dental Insurance Program (VADIP) offered by the Federal Government Programs division of Delta Dental.

Keep reading to learn more about what VA dental insurance does and does not cover.

What does VA dental insurance cover?

The type of dental benefits you are entitled to through the VA will vary depending on factors such as your military service record, medical condition, and living situation. There are several classes of benefits, and what VA dental insurance covers depends on which one you are in.

Here are the classes of VA benefits and the dental procedures covered by each class:

  1. Class I: You are paid for a disability or dental condition related to your service (monthly payments). Class I veterans can qualify for all necessary dental services.
  1. Class IIC: You are a former prisoner of war (POW) and can benefit from all the dental services you may need.
  1. Class IV: You have one or more service-related disabilities, all considered 100% disabling. You may be eligible for 100% of all necessary dental treatments and procedures.

You are not eligible for this benefit if you are paid at 100% disability based on a temporary assessment, such as a long hospital stay or rehabilitation treatment.

  1. Class II: You served on active duty during the Persian Gulf War. Class II veterans may be eligible for one-time dental treatment or surgery if all of the following conditions are met:
  • You were not dishonorably discharged.
  • You must apply for dental insurance within 180 days of your leave.
  • Your DD214 discharge certificate should not indicate that you had a thorough dental examination before your discharge and that you received the necessary dental treatment.

Note: You can no longer receive class II outpatient dental care if you received a letter from the VBA before 1955 stating that your dental problems are not compensable. This is due to Public Law 83, which changed the rules for who can receive outpatient dental care on June 16, 1955.

  1. Class IIA: You suffer from a non-compensable service-related dental condition, which means that you do not receive disability benefits for this condition. You also have a disability caused by battle wounds or service trauma. You may be eligible for all the dental care you need to maintain a set of functioning teeth.

Note: A Dental Trauma Assessment (VA Form 10-564-D) or Regional VA Office Assessment Decision Letter (VA Form 10-7131) will tell you which teeth or conditions are being assessed for trauma. .

  1. Class III: Your VA dentist thinks that your dental problem is related to a health problem that you had because of your service and which aggravates this health problem. You may be able to receive dental treatment to address oral problems that a VA dentist determines are aggravating your service-related condition.
  1. Class V: You are an active member of a 38 USC Chapter 31 Veterans Readiness and Employment Program. Class V entitles you to VA dental care to help you achieve these goals:
  • Allow you to participate in the employment program
  • Ensure Your Veteran Readiness and Employment Program Achieves its Goals
  • Avoid having to give up your job search
  • Help you resume your employment program more quickly if you had to stop (and you are in “interrupted” or “leave” status)
  • Helping you get back into your employment program faster if you had to quit due to illness, injury or dental issues and are in a “dropped out state”
  • While you are receiving employment assistance, helping you find and adjust to a job
  • Allow you to do everything you need to do by yourself
  1. Class VI: You are receiving care from the VA or are scheduled for hospital care for a medical condition. You also need dental care because a dental problem makes it more difficult to treat your health problem. You may qualify for dental care if a VA dental provider finds that a dental problem is making the health condition you are being treated for more difficult to treat.
  1. Class IIB: You have enrolled in the Dental Program for Homeless Veterans (VA Directive 2007-039). Class IIB qualifies you for a unique course of dental treatments to help you:
  • To get a job
  • Take away your pain
  • Manage moderate, severe or complicated gum and tooth problems as well as serious periodontal problems such as gum infections which can lead to pain, swelling and loss of bone and teeth if not addressed treaties
  1. Hospital status: You are treated in a hospital, nursing home or other supervised place but in a setting similar to your home (home care). You can receive VA dental treatments from a VA dental provider who works in conjunction with your primary care physician to manage a health condition for which you are being treated.

To apply for VA dental care, complete the 10-10EZ Health Care Application.

Items VA Dental Insurance Does Not Cover

VA dental insurance covers many essential services to help veterans maintain good oral health. However, there are some things that VA dental insurance does not cover, including:

  1. Services and treatments not prescribed or supervised by a dentist, except in states where dental hygienists may practice without supervision
  1. Experimental or Experimental Services or Treatments
  1. Treatments for injuries arising in the course of employment
  1. Unnecessary or substandard dental services and treatments
  1. Procedures considered to be purely cosmetic in nature such as customizing a prosthetic appliance such as crowns, bridges, dentures, implants and veneers
  1. Services or treatment required due to self-inflicted injury or illness
  1. Sealants for patients 16 years and older
  1. Replacement of lost, stolen or misplaced prostheses
  1. Orthodontic services and appliances
  1. Gold leaf restorations

Although VA dental insurance does not cover these procedures, it is possible to purchase a supplemental insurance plan that will add coverage for things excluded from coverage.

Can you top up VA dental insurance?

Not all veterans receiving VA health care benefits are eligible for free dental services. Many veterans may be able to get some of their dental care for free, but this is not always the case. If you are a veteran and do not qualify for free dental care through the VA, VADIP may be able to help pay for private dental insurance.

If you need dental care but already receive some of it for free through the VA, you can purchase a VADIP plan as additional coverage. Joining VADIP will not affect your eligibility for free VA dental care. If you qualify for free dental care from the VA for a portion of your needs, but also want additional dental insurance, you can purchase a VADIP plan through Delta Dental or MetLife.

VADIP covers these essential dental procedures:

  • Diagnostic
  • Dental prevention
  • Root canal treatments and other oral health services to restore function (called endodontic or restorative services)
  • Orthodontics
  • Dental emergencies
  • Insurance costs depend on your company and plan

Depending on your plan, you will pay:

  • The full insurance premium for each person
  • All necessary copays

Compare VA Dental Insurance

If you are an active or retired member looking for dental insurance, you can start your search by considering these dental providers that Benzinga has reviewed based on benefit options, customer service, customer satisfaction, and more. complaints and virtual payment platforms of each company.

Frequently Asked Questions

Can I receive VA dental benefits for some or all of my dental work?

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Can I receive VA dental benefits for some or all of my dental work?

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Janet Hunt, insurance agent

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It depends on many things including how long you have been in the military and your current health and living situation. Based on these, the VA places you in a benefit class and gives you the benefits of that class.

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If I don’t qualify for VA dental care, can I get help paying for dental insurance?

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If I don’t qualify for VA dental care, can I get help paying for dental insurance?

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Janet Hunt, insurance agent

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If you are not eligible for VA dental benefits, you may be able to purchase dental insurance at a discount through coverage provided by the VA Dental Insurance Program (VADIP).

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Benzinga

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