What is TRICARE Insurance?
Active-duty service members (ADSMs), National Guard/Reserve members, veterans, and their families are eligible for the TRICARE health insurance program. Most medically and psychologically necessary services are covered through TRICARE health plans, including mental health treatments and substance use disorder (SUD) treatments.
Does TRICARE Cover Drug Rehab?
Yes, TRICARE covers most mental health and drug and alcohol rehab treatment services. Most inpatient services, whether an emergency or a non-emergency visit, are covered, including the following:
- Emergency care
- Inpatient hospital visits for emergencies
- Inpatient hospital services
- Medical detoxification
- Intensive outpatient programs (IOP)
- Medication-assisted treatment (MAT)
- Mental health therapeutic services
- Partial hospitalization programs (PHP)
Addiction Treatment Services Covered By TRICARE
TRICARE insurance coverage includes intensive outpatient programs (IOP) for substance use disorders (SUDs) for those who don’t need hospitalization but could benefit from drug and alcohol rehab. Intensive outpatient programs for drug and alcohol addiction are beneficial for individuals with less severe addictions who have already undergone other drug treatments.
Partial hospitalization programs (PHP) for substance use disorders (SUDs) and psychiatric disorders offer coverage through TRICARE as many veterans and active-duty service members (ADSMs) struggle with mental health and substance use disorders (SUDs) alone or simultaneously—which would qualify for dual diagnosis treatment. PHP benefits those needing short-term hospitalization for their drug or alcohol addiction.
Does TRICARE Cover Medical Detox?
TRICARE covers managing drug and alcohol withdrawal through medical detoxification at a treatment facility. Medication-assisted treatment (MAT) combines drug and mental health therapies. MAT is only covered by TRICARE when certified by the Drug Enforcement Agency (DEA) for the prescription of buprenorphine as a replacement drug.
Does TRICARE Cover Prescription Costs for Medication-Assisted Treatment (MAT)?
TRICARE covers most medically and psychologically necessary prescriptions, including buprenorphine (suboxone) for medication-assisted treatment (MAT). To obtain a prescription covered by insurance, TRICARE members must receive prior authorization from the DEA.
Does TRICARE Cover Mental Health Treatments?
Yes, TRICARE covers a variety of mental health treatments. Whether individual, group, or family sessions, psychotherapy is covered by TRICARE plans. TRICARE members will also receive coverage for family therapy and marriage counseling services. TRICARE provides coverage for psychological testing and assessment services for substance use disorders (SUDs) and various mental health disorders and conditions.
Ancillary or experiential therapies are covered when part of the treatment programs at rehab facilities or psychiatric centers. Experiential therapies can include art, music, dance, nature, adventure, and other ancillary therapeutic activities provided in the program.
TRICARE Health Plans
TRICARE health insurance is classified into TRICARE Prime and TRICARE Select. Health maintenance organizations (HMO) and preferred provider organization (PPO)-style plans are available through TRICARE health insurance.
TRICARE Prime
TRICARE Prime is the required health insurance plan for all active-duty service members (ADSMs). All TRICARE Prime, HMO-managed—health maintenance organization—programs receive assistance from a primary care manager (PCM). Prime plans provide coverage for active and retired military members and their families, in addition to activated Guard/Reserve members and their families. Prime offers fewer provider options: however, members have fewer out-of-pocket expenses.
TRICARE Prime covers most mental health and drug and alcohol addiction treatment services, including IOP, OP, and medical detox. TRICARE Prime Remote is an insurance plan for active-duty members that qualify for Prime but are stationed approximately 50 miles from the closest military hospital.
TRICARE Select
TRICARE Select is an additional option for active and retired military members and their families. If you’re an active-duty service member (ADSM) or activated Guard/Reserve member, you can only use Select if you live in an area where you cannot use Prime.
PPO-style, preferred provider organization plans, such as TRICARE Select, Select Overseas, Reserve Select, and Retired Reserve plans, are all self-managed. Select members have a more comprehensive selection of providers, but the out-of-pocket costs are higher. Special programs offer similar service coverage to Prime, although specific services require an authorization process before approval.
Choosing A Rehab Center In-Network With TRICARE
To receive the most affordable costs and services for drug and alcohol rehab, ensuring that the treatment center you choose is in-network with the TRICARE health insurance plan is crucial. Depending on your plan, your primary care manager (PCM) can assist you in finding rehab centers in-network with TRICARE. You can also contact your treatment center of choice for more information on their insurance providers.
Here at Rock Recovery Center in West Palm Beach, Florida, we are proudly in-network with TRICARE health insurance, providing evidence-based, holistic treatment services for those struggling with a substance use disorder (SUD).
References:
- National Alliance on Mental Illness, 2017. Understanding Dual Diagnosis.
- Alcohol and Drug Foundation, 2021. What is Buprenorphine?
- Psychology Today, 2021. Experiential Therapy.
- Rock Recovery Center. Drug and Alcohol Rehab Programs.
