TRICARE Colorectal Cancer Exam Coverage & Costs (2026)
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## Quick answer TRICARE covers colorectal cancer screenings for average-risk beneficiaries starting at age 45. Depending on your plan (Prime or Select), these screenings are generally $0 out-of-pocket when using network providers, as they are considered essential preventive care. High-risk individuals may qualify for earlier or more frequent testing.
## In detail Effective clinical guidelines evolved in recent years to lower the recommended screening age from 50 to 45. TRICARE aligns with the U.S. Preventive Services Task Force (USPSTF) recommendations, covering several types of screening methods.
### Covered Screening Methods TRICARE covers the following tests for colorectal cancer: * **Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT):** Annual stool-based tests. * **Stool DNA Tests (e.g., Cologuard):** Typically covered once every 1 to 3 years. * **Flexible Sigmoidoscopy:** Covered every 5 years. * **Optical Colonoscopy:** The "gold standard" screening, covered every 10 years for average-risk individuals. * **Computed Tomographic Colonography (Virtual Colonoscopy):** Covered when physical colonoscopy is contraindicated or failed.
### Costs and Copays (2026 Plan Year) For most beneficiaries, colorectal cancer screening is a **covered preventive service**, meaning you pay nothing if you follow the rules of your plan.
| Plan Type | Network Provider (In-Network) | Non-Network Provider (Out-of-Network) | | :--- | :--- | :--- | | **TRICARE Prime** | $0 Copay | Point-of-Service (POS) charges apply | | **TRICARE Select** | $0 Copay | Applicable deductible and cost-share | | **TRICARE For Life** | $0 (if Medicare-covered) | Medicare deductible/cost-share applies |
*Note: If a screening colonoscopy finds a polyp and it is removed during the procedure, it may be reclassified from "preventive" to "diagnostic." Under 2026 rates, most plans still waive the cost-share for the first surgical procedure in a preventive session, but check with TriWest (West) or Humana Military (East) for specific billing codes.*
### Regional Management * **East Region:** Managed by Humana Military. * **West Region:** Managed by TriWest Healthcare Alliance. * **Overseas:** Managed by International SOS.
## Who this applies to * **Active Duty Service Members (ADSMs):** Required to stay current on medical readiness; screenings are handled via military clinics or referrals. * **Active Duty Family Members (ADFMs):** Covered at $0 in-network. Prime users need a referral for a specialist; Select users do not. * **Retirees and their Families:** Covered beginning at age 45. Group A and Group B beneficiaries have different enrollment fees, but preventive screenings remain $0 in-network for both. * **TRICARE Reserve Select (TRS) & TRICARE Retired Reserve (TRR):** Follow the same preventive care guidelines as Select.
Common scenarios
**Scenario 1: The Prime Referral** Jane is a 46-year-old spouse of an active-duty soldier in the East Region (Humana Military) enrolled in TRICARE Prime. She visits her Primary Care Manager (PCM), who submits a referral for a colonoscopy. Jane goes to a network gastroenterologist. Under 2026 rates, Jane pays **$0** for the procedure and the anesthesia.
**Scenario 2: Select Self-Referral** Mark is a 50-year-old retiree in the West Region (TriWest) using TRICARE Select. He decides to get a Cologuard (Stool DNA) test. Because he sees a network provider and the test is an approved preventive service, his cost-share is **$0**, even if he hasn't met his annual deductible yet.
**Scenario 3: High-Risk Screening** David is 35 and has a first-degree relative who had colon cancer at age 40. Because he is "high-risk," TRICARE covers his colonoscopy before the standard age of 45. As long as he uses a network provider, his cost is **$0**.
## Related terms * **Polyps:** Small growths on the inner lining of the colon; some can turn into cancer over time. * **Gastroenterologist:** A doctor who specializes in the digestive system and performs colonoscopies. * **Point-of-Service (POS) Option:** An additional cost incurred by Prime members who see a specialist without a referral from their PCM. * **Cost-Share:** The percentage of the total cost a beneficiary pays after the deductible is met. * **USPSTF:** The U.S. Preventive Services Task Force, which sets the national standards for cancer screenings.
## Sources * TRICARE.mil - Colorectal Cancer Screenings: https://www.tricare.mil/CoveredServices/IsItCovered/ColorectalCancerScreening * Defense Health Agency (DHA) - Preventive Care Guidelines: https://health.mil/ * Humana Military (East Region): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West Region): https://www.triwest.com/