| Services Covered |
TRICARE Prime* |
TRICARE Extra |
TRICARE Standard |
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Clinical Preventive Examinations
Comprehensive-health-promotion and disease-prevention exams for ages 24 months and older.
Examinations can include: blood pressure tests; clinical breast exams (high-risk women age 39 and under; annually for all women over 40); pelvic exams (same guideline as Pap smears and should be administered during same visit); clinical testicular exams (annually for high-risk men 13-39); digital rectal exams (annually for high-risk men 40-49; and all men over 50); Prostate Specific Antigen (annually for high-risk men 40-49; men with history of vasectomy at least 20 years previous or at age 40 and over; and all men over 50); oral cavity exams; thyroid palpations; school enrollment physicals ages 5-11 years.
Note: Annual sports physicals are not a covered benefit under TRICARE.
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No copayment
Clinical preventive services are an enhanced benefit under TRICARE Prime.
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Applicable cost-share and deductible apply. |
Applicable cost-share and deductible apply.
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Eye Examinations
Clinical preventive service eye exams vary by TRICARE program option (see columns for details of coverage for children and adults).
Except for active duty service members (ADSMs), lenses or eyeglasses are only cost-shared for treatment of infantile glaucoma, keratoconus, dry eyes, and irregularities in the shape of the eye.
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For Infants:
No copayment
One eye and vision screening by the beneficiary’s PCM during routine exam at birth and 6 months of age. Exam to include screening for visual acuity, ocular alignment, and red reflex along with external examination for ocular abnormalities.
For Adults and Children Age 3 and over:
No copayment
One comprehensive eye exam by a specialist (ophthalmologist or optometrist) including screening for visual acuity and glaucoma every two years.
Diabetic patients at any age are covered for one comprehensive eye exam yearly.
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For Children:
Covered under Well-Child Care benefit.
Applicable cost-share and deductible apply.
One eye and vision screening by a TRICARE network provider during routine exam at birth and 6 months of age.
Two comprehensive eye exams by specialist (ophthalmologist or optometrist) for amblyopia (vision loss) and strabismus (cross eye) between 3-6 years of age.
For Adults:Not covered
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For Children:
Covered under Well-
Child Care benefit.
Applicable cost-share and deductible apply. One eye and vision screening by a TRICARE network provider during routine exam at birth and 6 months of age. Two comprehensive eye exams by specialist (ophthalmologist or optometrist) for amblyopia (vision loss) and strabismus(cross eye) between 3-6 years of age.
For Adults: Not covered
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Immunizations
Age appropriate doses of vaccines recommended and adopted by the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP). Refer to CDC's Web site for a current schedule of recommended vaccines.
Immunizations for Overseas Travel: See information listed in the Outpatient Services Outside of the MTF section of these charts. |
No copayment |
Applicable cost-share and deductible apply. |
Applicable cost-share and deductible apply.
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Patient and Parent Education or Counseling Services
The following education or counseling services are covered when included as part of an office visit: dietary assessment and nutrition; physical activity and exercise; cancer surveillance; safe sexual practices; tobacco, alcohol, and substance abuse; accident and injury prevention; promoting dental health; stress, bereavement, and suicide risk assessment. |
No copayment |
Applicable cost-share and deductible apply. |
Applicable cost-share and deductible apply.
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Periodic Screening Examinations
Beneficiaries will be offered age- and gender-appropriate screening tests for the early detection of disease and/or disease risk factors, including:
Cancer Screening: Annual screening mammograms for women over the age of 39, (for high-risk baseline at 35 years, then annually); Pap smears (see below); proctosigmoidoscopy or sigmoidoscopy (once every 3-5 years beginning at age 50); colonoscopy (every 2 years beginning at age 25 or 5 years younger than the earliest age of diagnosis for colon rectal cancer, whichever is earlier, and then annually after age 40 for individuals with hereditary nonpolyposis colon rectal cancer syndrome. Individuals with familial risk of sporadic colon rectal cancer (i.e. individuals with first degree relatives with sporadic colon rectal cancer or adenomas before the age of
60 or multiple first degree relatives with colon rectal cancer or adenomas) may receive a colonoscopy every 3 to 5 years beginning at age 10 years earlier than the youngest affected relative), and fecal occult blood testing (annually age 50 and above); skin cancer exams (for high-risk individuals with family history or increased exposure to sunlight).
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No copayment |
Applicable cost-share and deductible apply. |
Applicable cost-share and deductible apply.
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Routine Pap Smears: Annually starting at age 18 (or younger if sexually active) until three consecutive satisfactorily normal annual examinations. Frequency may be less often at the discretion of the patient and the clinician, but not less than every three years.
Infectious Disease Screening: Screening for Hepatitis B, Rubella antibodies, and HIV and screening and/or prophylaxis for tetanus, rabies, Rh immune globulin, Hepatitis A&B, meningococcal meningitis, and tuberculosis
Cardiovascular: Cholesterol (once every 5 years beginning at age 18) and blood pressure (children: annually between ages 3-6 and every 2 years thereafter; adults: minimum every 2 years)
Hearing: Preventive hearing screenings for all high-risk neonates as defined by the Joint Committee on Infant Hearing. A newborn audiology screening should be performed on high-risk newborns prior to hospital discharge or within the first three months. Evaluative hearing tests may be performed at other ages during routine exams.
Other: Assessment of risk for lead exposure by structured questionnaire (during each Well-Child Care visit from 6 months to 6 years); blood lead test for all children determined to be high-risk. |
No copayment |
Applicable cost-share and deductible apply. |
Applicable cost-share and deductible apply.
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Well-Child Care
Well-Child Care (birth to 6 years) includes routine newborn care; comprehensive health promotion and disease prevention exams; vision and hearing screenings; height, weight, and head circumference; routine immunizations; and developmental and behavioral appraisal in accordance with the American Academy of Pediatrics (AAP) and CDC guidelines. |
No copayment |
Applicable cost-share and deductible apply. |
Applicable cost-share and deductible apply.
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*TRICARE Prime beneficiaries may receive clinical preventive services from any network provider without a referral or pre-authorization.
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