10 Things VA Dental Insurance Doesn’t Cover

Some or all of your dental care needs may be met by the Veterans Administration (VA) if you are eligible for VA dental care benefits. Even if you don’t qualify for full dental care through the VA, military retirees have other options, including coverage through Federal Employees Dental and Vision Insurance Program (FEDVIP) administered by BENEFEDS or through Delta Dental’s Veterans Affairs 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 qualify for through the VA varies based on factors such as your military service record, state of health and living situation. There are several benefit classes, and what VA dental insurance covers depends upon which one you are in.

Here are the VA benefit classes and what dental procedures are covered by each class:

1. Class I: You get paid for a dental disability or condition that is linked to your service (monthly payments). Veterans in Class I can qualify for all dental care services needed. 

1. Class IIC: You are a former prisoner of war (POW) and can qualify for all dental services you may need.

1. Class IV:  You have one or more service-related disabilities, all of which are considered to be 100 % disabling. You may qualify for 100% of all dental treatments and procedures needed. 

You cannot qualify for this benefit if you're getting paid at the 100% disabling rate based on a temporary rating, such as a long stay in the hospital or rehab care.

1. Class II: You served as an active-duty service member in the Persian Gulf War. Class II veterans may qualify for a one-time dental treatment or procedure if all of the following requirements are met:

• You were not dishonorably discharged.
• You must apply for dental coverage before 180 days after you’ve been discharged. 
• Your DD214 discharge certificate must not state you had a thorough dental exam before discharge and received any needed dental treatment. 

Note: You can no longer get Class II outpatient dental care if you got a letter from the VBA before 1955 saying that your dental problems aren't compensable. This is because of Public Law 83, which changed the rules about who could get outpatient dental care on June 16, 1955.

1. Class IIA: You have a service-related noncompensable dental condition, which means you don't get disability payments for it. You also have a disability caused by combat wounds or service trauma. You may be eligible for any dental care you require to  keep a set of functioning teeth.

Note: A Dental Trauma Rating (VA Form 10-564-D) or a VA Regional Office Rating Decision letter (VA Form 10-7131) will tell you which tooth/teeth or condition(s) are trauma rated.

1. Class III: Your VA dentist thinks your dental problem is linked to a health problem you got because of your service and is making that health problem worse. You may be able to receive dental care to fix oral problems that a VA dentist says are making your service-related health condition worse.

1. Class V: You are an active member of a 38 U.S.C Chapter 31 Veteran Readiness and Employment program. Class V entitles you to VA dental care to help you achieve these goals:

• Allow you to take part in the employment program
• Make it possible for your Veteran Readiness and Employment program to reach its goals
• Keep you from having to give up on your job search
• Help you get back to your job program faster if you had to stop (and are in "interrupted" or "leave" status)
• Help you get back to your employment program faster if you had to stop because of an illness, injury or dental problem and are in "discontinued status"
• During the time you receive employment assistance, help you find a job and get used to it
• Make it possible for you to do everything you need to do on your own

1. Class VI: You get care from the VA or are scheduled for inpatient care for a health problem. You also need dental care because a dental problem is making it harder to treat your health problem. You may be qualified for dental care if a VA dental care provider finds that a dental problem is making the health problem you're being treated for harder to treat.

1. Class IIB: You signed up for the Homeless Veterans Dental Program (VA Directive 2007-039). Class IIB qualifies you for a one-time course of dental treatments to help you:

• Get a job
• Take away your pain
• Take care of gum and tooth problems that are moderate, severe or complicated as well as serious periodontal problems such as gum infections that can lead to pain, swelling and bone and tooth loss if not treated

1. Inpatient Status: You get care in a hospital, a nursing home or another place that is supervised but in a setting similar to your own home (called domiciliary care). You can receive VA dental treatments from a VA dental-care provider who works in conjunction with your primary care physician to manage a health condition you are being treated for.

To apply for VA dental care, fill out the 10-10EZ healthcare application.

Items VA Dental Insurance Doesn’t Cover

VA dental insurance covers many essential services to help veterans keep good oral health. However, there are some things VA dental insurance doesn’t cover including:

1. Services and treatment not prescribed or supervised by a dentist, except in states where dental hygienists can practice unsupervised

1. Experimental or investigational services or treatments

1. Treatments for injuries occurring in the course of employment

1. Unnecessary or substandard dental services and treatment

1. Procedures considered to be only cosmetic in nature such as personalization of a prosthetic device like crowns, bridges, dentures, implants and veneers

1. Services or treatments needed because of self-inflicted injury or illness

1. Sealants for patients 16 or older

1. Replacement of dentures that have been lost, stolen or misplaced

1. Orthodontic services and devices

1. Gold foil restorations

Although VA dental insurance doesn’t cover these procedures, it is possible to buy a supplemental insurance plan that will add coverage for things excluded from coverage.

Can You Supplement VA Dental Insurance? 

Not all veterans with VA healthcare benefits are eligible for free dental services. Many veterans may be able to get some of their dental care requirements covered for free, but this is not always the case. If you are a veteran and do not qualify for free dental treatment via the VA, VADIP may be able to help you afford private dental insurance.

If you require dental treatment but are already receiving some of it for free through the VA, you can purchase a VADIP plan as supplemental coverage. Joining VADIP won't affect your eligibility for free VA dental care. If you are qualified to get free dental treatment from the VA for part of your needs but you also want additional dental insurance, you can purchase a VADIP plan through either Delta Dental or MetLife. 

VADIP covers these essential dental procedures:  

• Diagnostics
• Dental prevention
• Root canals 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'll pay: 

• Each person's full insurance premium
• Any necessary copays

Compare VA Dental Insurance

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

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