TRICARE to Expand Preventive Service Coverage

TRICARE has always had excellent coverage of important preventive services and we are making it better.  TRICARE is adding new services and screenings to ensure our preventive services are aligned with recommendations of the United States Preventive Services Task Force (USPSTF), and the Health Resources and Services Administration’s (HRSA) guidelines.

Effective Jan.1, 2017, TRICARE will cover annual preventive office visits for all Prime beneficiaries 6 years of age and older. Children under 6 are already covered by existing well-child coverage. This will ensure children in developing stages receive observation, physical examination, screening, immunizations, and various counseling services. TRICARE Standard beneficiaries can receive preventive services with no cost-share or copayment through Health Promotion and Disease Prevention (HP&DP) examinations (i.e. in connection with a covered immunization or cancer screening).

Additionally, the annual well-woman exam will continue to be covered for all Prime and Standard beneficiaries under age 65 with no cost-share or copayment. The new covered services include free genetic counseling by a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. before BRCA1 or BRCA2 gene testing for women who are identified as high risk for breast cancer by their primary care providers as well as the BRCA1 or BRCA2 gene testing for women who meet the coverage guidelines under the existing laboratory developed test (LDT) demonstration project.

TRICARE will also cover stool DNA testing (e.g., Cologuard™) once every 3 years starting at age 50 for those who have an average risk of colon cancer.  The effective date of Cologuard coverage is June 21, 2016.  

If you have recently received any of these services, please be sure to save your receipts and file a claim.  The regional contractors will be ready to process claims for the new preventive benefits on Nov. 14, 2016, the implementation date of this change.  The implementation date is the date the contractor must be ready to communicate and process claims for this benefit. 

You can find information on both Medical Claims and Covered Services on the TRICARE website.