TRICARE Cancer Coverage: Costs, Trials & Referrals (2026)

*TRICARE.com is an independent reference site and is not a government agency. For official policy and individual benefit determinations, visit TRICARE.mil.*

## Is it covered? Yes, TRICARE covers all medically necessary services for the diagnosis and treatment of cancer. This includes chemotherapy, radiation, surgery, and participation in certain NCI-sponsored clinical trials.

## What TRICARE covers TRICARE’s coverage for oncology is broad and follows the standard of care recognized by the National Cancer Institute (NCI). Generally, if a treatment is proven safe and effective (not "investigational"), it is covered.

**Covered Services:** * **Diagnostic Testing:** Biopsies, CT scans, MRIs, PET scans, and genetic testing (when used to determine specific treatment pathways). * **Active Treatment:** Chemotherapy, immunotherapy, hormone therapy, and radiation therapy (including proton beam therapy for specific cancers). * **Surgery:** Tumor removal, lymph node dissection, and reconstructive surgery following cancer treatment (e.g., breast reconstruction after a mastectomy). * **Hospitalization:** All inpatient stays required for surgical recovery or intensive treatment. * **Prescription Drugs:** Intravenous drugs administered in a clinic and oral chemotherapy medications through Express Scripts. * **Clinical Trials:** TRICARE covers the "routine costs" of participation in National Cancer Institute (NCI) sponsored Phase I, Phase II, and Phase III clinical trials.

**What is NOT covered:** * **Experimental/Investigational Treatments:** Procedures or drugs not yet approved by the FDA or not widely recognized as the standard of medical practice. * **Alternative Medicine:** Gerson therapy, high-dose vitamin C infusions, or other non-traditional cancer treatments. * **Wigs (Cranial Prosthetics):** Generally not covered unless the hair loss is a result of treatment for a covered medical condition (though TRICARE typically limits this benefit; check your specific regional contractor for 2026 updates).

## Costs Your out-of-pocket costs depend on your beneficiary category (Group A vs. Group B) and your specific plan. All costs below are based on **2026 rates**.

* **TRICARE Prime:** Active duty service members (ADSMs) have $0 out-of-pocket costs. Family members on Prime generally pay $0 for covered oncology services when referred by their Primary Care Manager (PCM). * **TRICARE Select:** * **Group A (Enlisted):** Outpatient specialty visits usually cost approximately $30–$40 per visit; inpatient stays are a flat rate per day or a small percentage. * **Group B (Joined after 2018):** Small deductible applies, followed by a 20% cost-share for in-network specialty care. * **TRICARE For Life (TFL):** As long as the treatment is covered by both Medicare and TRICARE, TFL usually pays the remaining balance after Medicare pays its portion, resulting in $0 out-of-pocket for most cancer patients.

*Note: All TRICARE plans have a **Catastrophic Cap** (ranging from $1,000 to $4,171 depending on status and plan in 2026). Once you hit this limit, TRICARE pays 100% of covered costs for the rest of the calendar year.*

## Pre-authorization & referrals Navigating cancer care requires strict adherence to referral rules to avoid "Point of Service" charges:

* **TRICARE Prime:** You **must** have a referral from your PCM for oncology. Most specific treatments (like chemotherapy or specialized imaging) will also require **prior authorization** from your regional contractor (Humana Military in the East or TriWest in the West). * **TRICARE Select:** You do not need a referral to see an oncologist, but many specific high-cost treatments (e.g., PET scans, certain specialty drugs, or clinical trials) still require **prior authorization**. * **TRICARE For Life:** No referrals are needed as long as you see a provider who accepts Medicare.

## Where to get care How you access care depends on your location and regional contractor:

1. **Military Hospitals and Clinics:** Depending on the facility's size, you may be able to receive oncology care on-base at a Military Treatment Facility (MTF). 2. **East Region:** If you are in the East, use the [Humana Military Provider Directory](https://www.humanamilitary.com) to find network oncologists. 3. **West Region:** If you are in the West, use the [TriWest Healthcare Alliance Provider Directory](https://www.triwest.com) (effective Jan 1, 2025). 4. **Specialized Centers:** For complex cases, your contractor may authorize care at an NCI-Designated Cancer Center.

## Sources * TRICARE Policy Manual 6010.60-M, Chapter 4 (Therapeutic Services): [TRICARE.mil](https://manuals.health.mil/) * TRICARE Clinical Trials Benefit: [TRICARE.mil/clinicaltrials](https://www.tricare.mil/clinicaltrials) * Defense Health Agency (DHA) Cancer Treatment Overview.