COVID-19 Testing: What TRICARE Covers

7/28/2020

You may have questions about COVID-19 testing. Two kinds of tests are used to determine SARS-CoV-2 (the virus that causes COVID-19) infection: diagnostic (viral) and antibody testing. It’s important you know the difference between the tests, how to get tested, and what TRICARE covers. TRICARE covers diagnostic and/or antibody testing that’s medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and meets TRICARE policy, which follows the Centers for Disease Control and Prevention (CDC) guidance.

“A variety of COVID-19 diagnostic testing options are available to the public,” said Dr. Danita Hunter, director of the TRICARE Health Plan at the Defense Health Agency. “Before you get tested, learn more about COVID-19 testing and what TRICARE covers on TRICARE.mil.”

Diagnostic Test

A diagnostic (viral) test tells you if you have a current SARS-CoV-2 infection. The CDC reports that not everyone needs to get tested for COVID-19 and that testing differs by location. You should get tested if you’re experiencing COVID-19 symptoms and when it’s recommended by a health care provider. The test must be one approved, cleared, or authorized by the Food and Drug Administration (FDA). Your provider will use a screening process to determine whether you need to be tested following the CDC guidelines.  

Your local military hospital or clinic may be able to give you a test. You can also go to your state or local health department’s website for the latest information on testing in your area.

Some areas offer free diagnostic testing. You may get a free test, but know that the testing agency may still bill TRICARE. In this case, TRICARE will deny that claim. When this happens, the testing agency will pay the bill. You’ll get an explanation of benefits showing the denied claim. This doesn’t mean you must pay the bill.

TRICARE will waive copayments and cost-shares for approved SARS-CoV-2 diagnostic testing and office visits related to the testing. If you paid any copayments for testing related to COVID-19 and the resulting office visit with a network or non-network provider, you may file a claim for reimbursement. If you need treatment and/or prescriptions due to SARS-CoV-2 infection, then your copayments and cost-shares will still apply depending on your health plan. Active duty service members and active duty family members enrolled in TRICARE Prime don’t have cost-shares.

If you live overseas and have cost-shares, you may be eligible for a waiver of your cost-shareA percentage of the total cost of a covered health care service that you pay. for certain SARS-CoV-2 diagnostic testing. The test must be approved, cleared, or authorized by FDA, or approved by the host nation to test for COVID-19.

If you have TRICARE For Life and Medicare, follow Medicare’s guidance on coverage for testing and hospitalizations.

If you get tested, be sure to contact your doctor to document the results in your records. See the TRICARE Coronavirus FAQs to learn more.

Antibody Test

An antibody test might tell you if you had a past infection. According to the CDC, it can take up to three weeks after infection for your body to make SARS-CoV-2 antibodies.

TRICARE may cover a SARS-CoV-2 antibody test approved, cleared, or authorized by the FDA. Or, if you’re overseas, approved by the host nation. The test must be ordered by 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, and it has to be medically necessary, appropriate, and safe. This means that TRICARE won’t cover antibody blood tests to satisfy your curiosity, to see if you’re safe to return to work, for research purposes, or for public health outreach. See the TRICARE Coronavirus FAQs to learn more.

If you have already recovered from COVID-19, you may be able to join the fight to help others with the virus. The Department of Defense (DoD) aims to collect more than 10,000 units of convalescent plasma this summer to help sick active duty service members.

Stay Informed and Stay Safe    

The best way to approach testing is to contact your medical provider or TRICARE contractor before you get a test done, especially if you have questions about what the benefit covers.  

Even if you believe you already had COVID-19, you should still take precautions to avoid infection. Some precautions include wearing a cloth face covering, staying 6 feet apart, and washing your hands frequently. Continue to follow the guidance from the CDC, the DoD, and your local officials. Read about TRICARE and COVID-19, and take command of your health.

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Last Updated 7/28/2020