TRICARE Coverage for Cancer Care & Oncology
Overview
TRICARE covers comprehensive cancer care from screening through treatment and survivorship. This includes diagnostic testing, surgical oncology, chemotherapy, radiation therapy, immunotherapy, clinical trials, palliative care, and survivorship programs.
Treatment Options Covered by TRICARE
- Cancer screening (mammography, colonoscopy, pap smear, PSA)
- Diagnostic imaging and biopsy
- Surgical oncology
- Chemotherapy (inpatient and outpatient)
- Radiation therapy
- Immunotherapy
- Hormonal therapy
- Targeted therapy
- Clinical trials (NCI-sponsored)
- Palliative care
- Hospice care
- Cancer rehabilitation
- Genetic testing and counseling
- Fertility preservation before treatment
How TRICARE Covers Cancer Care & Oncology
TRICARE covers all medically necessary cancer care with no lifetime maximums. Preventive screenings are covered at $0 for network providers. TRICARE covers participation in NCI-sponsored clinical trials. Fertility preservation may be covered before cancer treatment when it would impact fertility.
Coverage by Plan
TRICARE Prime
Cancer treatment at $0 when referred through PCM and authorized. MTF oncology departments provide coordinated care. Second opinions covered.
TRICARE Select
Standard cost shares apply. Outpatient chemotherapy at network cost share. Inpatient care subject to per-day charges. No referrals needed.
TRICARE For Life
Medicare pays first for cancer care. TFL covers remaining costs. Most cancer treatment at $0 or near-$0 out of pocket.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| Screening mammogram (all plans) | $0 (covered as preventive) |
| Colonoscopy screening (all plans) | $0 (covered as preventive) |
| Chemotherapy cycle (Prime ADFM) | $0 with referral/authorization |
| Chemotherapy cycle (Select ADFM, network) | Standard outpatient cost share |
| Cancer surgery (Prime ADFM) | $0 |
| Annual cancer care (catastrophic cap) | Maximum $1,000 (ADFMs) to $3,500 (retirees) |
Authorization Requirements
Cancer treatment plans typically require authorization. Emergency cancer-related care does not require prior authorization. Referrals from PCM (Prime) initiate the authorization process. Second opinions are covered and encouraged.
Network & Provider Notes
TRICARE covers care at NCI-designated cancer centers and community oncology practices. Military treatment facilities have oncology departments at many major installations. For rare cancers, out-of-network referrals may be authorized.