Understanding TRICARE Coverage of COVID-19 Testing
If you have symptoms of COVID-19 and go to the doctor to get tested, will TRICARE cover your visit and your test? Will TRICARE cover your COVID-19 test if you don’t have symptoms but want to get a test for peace of mind? If you’re confused about COVID-19 tests and what TRICARE covers, be sure you check out the latest information on the TRICARE website.
“As COVID-19 cases rise, we know that more and more of our TRICARE beneficiaries may want to get tested,” said Elan Green, chief of the Medial Benefits and Reimbursement Section for the TRICARE Health Plan with the Defense Health Agency. “If you have questions about what’s covered and how to access care, there are resources to help support you. You can review TRICARE COVID-19 information, or reach out to your TRICARE contractor or medical provider.”
When it comes to COVID-19 testing, you should first know that TRICARE covers COVID-19 tests when they’re medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and appropriate. 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. DS must order the test. And the provider must perform the test at a TRICARE-authorized lab or facility. If you got an approved COVID-19 test done and paid a copaymentA fixed dollar amount you may pay for a covered health care service or drug. for the test or related office visit, you can file a claim for reimbursement.
To further help you understand your benefits, here are answers to some of the most popular questions about COVID-19 testing and TRICARE. Make note of them before you or a family member gets tested.
Q: Does TRICARE cover COVID-19 testing for active duty service members who have symptoms of COVID-19?
A: Yes. You should get a COVID-19 test at a military hospital or clinic when it’s possible. Report your results through your unit and medical channels. If you’re a National Guard or Reserve member called or order to active duty for more than 30 days, you must show as TRICARE-eligible in the Defense Enrollment Eligibility Reporting System, also known as DEERS. Your provider should reflect COVID-19 coding on the claim. Your provider will process the claim under the Supplemental Health Care Program.
Q: Does TRICARE cover COVID-19 testing for active duty service members who don’t have symptoms of COVID-19?
A: It depends. TRICARE will cover your test if it’s required to support your unit’s readiness mission or your deployment status. Report your results through your unit and your medical channels. You should get your test done through your service channels or at military hospital or clinic when possible.
Q: If you have TRICARE For Life, will TRICARE cover your COVID-19 testing?
A: It depends. You must follow the Medicare coverage rules. TRICARE will process your claim as secondary payer for services covered by both Medicare and TRICARE, including testing, treatment, and hospitalization.
Q: If you’re an active duty family member with COVID-19 symptoms, will TRICARE cover your test?
A: Yes. Your coverage is based on your health care provider’s clinical judgement and if the test is medically necessary and appropriate.
Q: You’re an active duty family member with no symptoms, and you’ve been exposed to a person with COVID-19 for a long period of time. Will TRICARE cover your test?
A: Yes, but not in all cases. Your coverage is based on your provider’s clinical judgement. The test must also be medically necessary and appropriate.
Q: Will TRICARE cover your test if you’re returning to work and you don’t have COVID-19 symptoms?
A: No. TRICARE, won’t cover your test unless you’re an active duty service member and it’s required for mission readiness or deployment.
You can find these scenarios and others, as well as more detail, on the TRICARE COVID-19 testing page. If you have a question about COVID-19 and your benefits that isn’t answered, you can contact your TRICARE contractor or health care provider. You can also visit the TRICARE FAQs and the Centers for Disease Control and Prevention website to learn more. If you get tested, make sure the results are documented in your medical records.
Last Updated 12/15/2020