TRICARE now covers preconception and prenatal carrier screenings, which were previously part of the Laboratory Developed Tests, or LDT, Demonstration. These screenings help identify genetic conditions that could impact the health of future children.
TRICARE screenings identify potential genetic conditions, helping individuals make informed family-planning choices. Covered conditions include cystic fibrosis, spinal muscular atrophy, Fragile X syndrome, Tay-Sachs disease, hemoglobinopathies, and more. These genetic tests have transitioned from the LDT Demonstration to TRICARE-covered medical benefits.
TRICARE has retroactively validated tests as covered screenings going back to December 27, 2021. This move aligns with a new law enacted to include such tests in TRICARE’s coverage. If you incurred out-of-pocket expenses for these screenings between the aforementioned date and the new policy’s commencement on July 19, 2023, contact your TRICARE regional contractor for claim instructions or reimbursement. Beneficiaries can seek reimbursement for tests conducted during this time or reprocess denied claims.
Although these six tests were initially part of the Laboratory Developed Tests Demonstration Project, they have now become integral to TRICARE coverage. This project has been extended for an additional five years until July 18, 2028. The initiative is to ensure that TRICARE beneficiaries have access to non-FDA-approved tests that meet specific safety and effectiveness criteria while adressing the rising availability of non-FDA-approved LDTs, encompassing tests for various medical conditions.
While this extension benefits eligible TRICARE beneficiaries with cost-sharing options for these tests, they must be conducted by laboratories adhering to quality standards defined by the Centers for Medicare and Medicaid Services.
To qualify for TRICARE coverage, you must fit within certain categories, such as Active Duty or Retired Uniformed Service Members, spouses and children of Active Duty or Retired Uniformed Service Members, National Guard or Reserve Members and their families, survivors of deceased Service Members, former spouses of Service Members, Medal of Honor recipients and their families, and those registered in the Defense Enrollment Eligibility Reporting System, DEERS. Service Members who separate due to a disease or disability connected to their service may qualify for specific TRICARE benefits.
For more information about TRICARE eligibility, click here.
Author: Rikki Almanza
Rikki is a Web Content Coordinator for the American Legion, Department of California. With a deep-rooted connection to the military, a spouse who is a Navy veteran, a father who served in the Air Force for 25 years, and a grandfather who proudly served, Rikki is committed to using her skills and knowledge to provide valuable assistance and resources to servicemembers and veterans.
