TRICARE to expand preventive service coverage

  • Published
  • By TRICARE Staff
TRICARE has always had excellent coverage of important preventive services and they are making it better. TRICARE is adding preventive services to ensure alignment with recommendations of the U.S. Preventive Services Task Force, and the U.S. Health Resources and Services Administration’s 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 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 provider 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 coverage guidelines under the existing laboratory developed test 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 anyone has recently received any of these services, they are advised to save their 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.

For more information on medical claims and covered services, visit the TRICARE website.