TRICARE Insurance For Addiction Treatment
In This Article
TRICARE Insurance Overview
TRICARE is the supplemental health care program available to active and retired military service members and their families.
The program includes health insurance coverage for service members in all branches of the United States Armed Forces, including:
- U.S. Air Force
- Marine Corps
- Coast Guard
- Commissioned Corps
- US Public Health Service
- Commissioned Core of the National Oceanic and Atmospheric Association
TRICARE made updates to the mental health benefits available to members. Plans now include coverage for drug and alcohol addiction treatment. The changes provide treatment and support that many military members dealing with addiction need.
TRICARE members have many options when it comes to medical insurance plans. Every plan available through TRICARE meets or exceeds the standards the Affordable Care Act (ACA) established.
Types of TRICARE Plans
Currently, there are eight different TRICARE programs available:
1. TRICARE Prime
Provides managed care coverage in specific geographical locations that are considered ‘prime’ areas in the U.S.
This plan has no copays or deductibles for the insured or their beneficiaries.
2. TRICARE Prime Remote
Provides coverage in remote locations in the U.S., and some areas overseas.
3. TRICARE Standard and Extra
Requires a paid fee (but no enrollment) for members to receive services.
4. TRICARE Standard Overseas
Provides comprehensive coverage for people overseas.
5. TRICARE for Life
A Medicare option that provides additional coverage for those who have Medicare Part A and B.
6. TRICARE Reserve Select
A premium-based plan that covers qualified reserve service members and their families.
7. TRICARE Retired Reserve
Another premium-based plan that provides coverage for retired service members under the age of 60 and their families.
8. TRICARE Young Adult
Provides coverage for young adult children who aren’t eligible for other TRICARE plans.
Does TRICARE Cover Rehab for Drugs and Alcohol?
Drug and alcohol addiction treatment is available through TRICARE. The ACA requires that all insurance providers offer the same level of coverage for addiction and mental health treatment as they do for other illnesses and conditions.
TRICARE usually only provides full coverage for in-network treatment providers. Choosing an in-network treatment provider means you’re only responsible for a small portion of out-of-pocket costs.
Those enrolled in any of the following programs can use out-of-network treatment providers:
- TRICARE Select
- Reserve Select
- Retired Reserve
- Young Adult Select
- Family Health
- Prime Remote
Anyone who chooses to work with an out-of-network treatment provider might need to file individual claims and/or pay higher out-of-pocket costs.
What Rehab Services Does TRICARE Cover?
TRICARE provides coverage for several essential aspects of addiction treatment, including:
Detoxification is the first phase of recovery from a drug or alcohol addiction. Often, medically supervised detox is necessary. This is because many of the body’s responses to detox are life-threatening.
Medically managed withdrawal or detox uses medications and other therapies to ease the side effects of detox. This not only makes the process safer, but also increases the odds of long-term recovery.
Detoxing at home without medical support is very difficult. Many who try this will resume using or drinking to get rid of the withdrawal symptoms.
Not all rehab programs include medically supervised detox. If you are concerned about this phase of recovery, look for a program that provides:
- Medical stabilization and supervision
- Withdrawal symptom minimization
- Prevention of life-threatening withdrawal effects
- Assistance with transitioning to the next phase of rehab
Inpatient treatment for drug and alcohol addiction includes around-the-clock supervision and support. Participants spend 24 hours a day in an immersive and supportive environment.
Inpatient or residential treatment programs are usually the most expensive options, at least short-term. However, these programs allow people to focus entirely on recovery. This improves their chances of long-term sobriety.
In the end, going through addiction treatment is often less expensive than managing an addiction.
Outpatient treatment programs allow people struggling with addiction to get the care and support they need without living away from home. These programs are flexible and suit a variety of lifestyles.
TRICARE offers several outpatient programs, including:
Standard Outpatient Programs
These programs are the least intensive form of outpatient care. Participants attend therapy once or twice a week at an office-based TRICARE-approved center.
Intensive Outpatient Programs (IOPs)
IOPs are more intensive than standard outpatient programs. They include therapy appointments several days per week.
TRICARE covers IOP enrollees with substance use and/or psychiatric disorders.
These programs are appropriate for people transitioning from a partial hospitalization program (PHP) or inpatient or residential treatment center to outpatient care.
Partial Hospitalization Programs (PHPs)
PHPs are the most intensive outpatient programs. They require daily treatment that lasts approximately 4 to 8 hours a day. Participants live at home but spend their days in their treatment program.
TRICARE covers care provided by authorized partial hospitalization program facilities for mental health and substance use disorders.
Anyone seeking treatment in the United States or its territories can qualify for PHP coverage if they:
- Have a mental health disorder or substance use disorder (SUD)
- Can function in some major areas of life
- Don’t need full-time hospital care
- Require medical management of withdrawal/detox
- Need care to stabilize
- Have acute symptoms
- Need treatment for partially stabilized mental health disorders
- Are transitioning from an inpatient addiction treatment program
Medication-Assisted Treatment (MAT)
Medication-assisted treatment (MAT) is a substitution therapy. It satisfies cravings for certain addictive drugs like opioids with less-dangerous, less-addictive drugs (e.g., methadone).
The goal of MAT is to manage long-term cravings for a drug and return to normal life.
In addition to coverage for detox, inpatient, and outpatient drug rehab programs, TRICARE also offers:
- Emergency inpatient services
- Mental health therapeutic services
TRICARE covers the following mental health services:
- Psychological testing and assessment
- Psychotropic drugs
- Electroconvulsive treatment
- Collateral visits
- Other ancillary therapies
TRICARE does not cover:
- Aversion therapy
- Domiciliary facilities (halfway houses, supervised living, etc.)
- Other experimental therapies
How to Check Your Coverage
The best way to check your TRICARE coverage is to use the “What’s Covered” tool on the TRICARE website.
This tool allows you to search a database of covered services. You can search by category or keyword. The site also includes information about coverage limits and exclusions.
Paying for Uncovered Rehab Costs
Even with TRICARE coverage, you will likely have out-of-pocket expenses for addiction treatment. Supplemental insurance can help with the cost of uncovered healthcare expenses.
TRICARE supplemental insurance offers benefits to help offset the cost of outpatient and inpatient treatment. This includes:
- Doctor visits
- Emergency room visits
- Prescription medications
In some cases, the supplemental insurance plans cover all of the expenses beyond what TRICARE covers.
Supplemental insurance coverage is especially beneficial for people who have high out-of-pocket medical expenses and/or regularly utilized medical care. This includes people struggling with substance use disorders (SUDs).
To determine if supplemental insurance is right for you, calculate the cost of your annual out-of-pocket medical expenses. If the cost is higher than the cost of supplemental insurance, then extra coverage might be necessary.
USBA is one of the most popular TRICARE supplemental insurance providers.
Call to find out how much your insurance will cover
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- “TRICARE Substance Abuse Treatment Falls Short, Experts Say.” Nextgov.com. 15 Aug. 2012.
- “Substance Use Disorder Treatment | TRICARE.” TRICARE.
- “Paying for What TRICARE Doesn’t Cover - Military Benefits.” Military Families, 3 Nov. 2020.
- “Home | TRICARE.” TRICARE. 2019.
- “VA & TRICARE Information - VA/DoD Health Affairs.” U.S. Department of Veterans Affairs.