Covered Services

Learn more about what we cover -
including health, dental, and pharmacy.

Breast Exams

Covered by TRICARE?	Limits
Yes	When and how often depends on your age and breast cancer risk

TRICARE covers clinical breast exams during a covered Health Promotion and Disease Prevention (HP&DP) exam.

Exam	Recommended:
Annual Breast Exams	At your doctor's discretion.
Annual Mammograms	Women age 40 or older. Women age 30 and older who have a 15% or greater lifetime risk of breast cancer, according to risk assessment tools based on family history, or who have any of the following risk factors: History of breast cancer, Ductal Carcinoma In Situ (DCIS), Lobular Carcinoma In Situ (LCIS), Atypical Ductal Hyperplasia (ADH), or Atypical Lobular Hyperplasia (ALH) Extremely dense breasts when viewed by mammogram Known BRCA1 or BRCA2 gene mutation, First degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves Radiation therapy to the chest between the ages of 10 and 30 years History of Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a first degree relative with a history of one of these syndromes
Annual Breast Magnetic Resonance Imaging (MRI) (in addition to the annual mammogram)	Beginning at age 30, for women who have a 20% or greater lifetime risk of breast cancer. Your risk is determined by risk assessment tools based on family history, or if you have any of the following risk factors: Known BRCA1 or BRCA2 gene mutation First degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves Radiation therapy to the chest between the ages of 10 and 30 years History of Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a first degree relative with a history of one of these syndromes TRICARE covers genetic counseling provided by a TRICARE authorized provider before BRCA1 or BRCA2 gene testing: For women identified as high risk for breast cancer by their primary care manager. For men if it is medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and appropriate. If you have a history of radiation therapy to the chest between the ages of 10 and 30. If you have a history of LiFraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a parent, child or sibling with a history of one of these syndromes.

Exam

Recommended:

Annual Breast Exams

At your doctor's discretion.

Annual Mammograms

Women age 40 or older.
Women age 30 and older who have a 15% or greater lifetime risk of breast cancer, according to risk assessment tools based on family history, or who have any of the following risk factors:
- History of breast cancer, Ductal Carcinoma In Situ (DCIS), Lobular Carcinoma In Situ (LCIS), Atypical Ductal Hyperplasia (ADH), or Atypical Lobular Hyperplasia (ALH)
- Extremely dense breasts when viewed by mammogram
- Known BRCA1 or BRCA2 gene mutation,
- First degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
- Radiation therapy to the chest between the ages of 10 and 30 years
- History of Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a first degree relative with a history of one of these syndromes

Annual Breast Magnetic Resonance Imaging (MRI)

(in addition to the annual mammogram)

Beginning at age 30, for women who have a 20% or greater lifetime risk of breast cancer. Your risk is determined by risk assessment tools based on family history, or if you have any of the following risk factors:

Known BRCA1 or BRCA2 gene mutation
First degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
Radiation therapy to the chest between the ages of 10 and 30 years
History of Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a first degree relative with a history of one of these syndromes

TRICARE covers genetic counseling provided by a TRICARE authorized provider before BRCA1 or BRCA2 gene testing:

For women identified as high risk for breast cancer by their primary care manager.
For men if it is medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and appropriate.
If you have a history of radiation therapy to the chest between the ages of 10 and 30.

If you have a history of LiFraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a parent, child or sibling with a history of one of these syndromes.

Disclaimer:

This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 6/5/2018