Tricare Insurance Coverage for Rehab

Drug and alcohol addiction treatment is an important part of healthcare that millions of people need. Despite this pressing need, many people may avoid seeking out treatment due to the cost.

It’s important to know your payment options when it comes to addiction treatment, particularly the coverage you may receive via insurance.

Serving about 9.6 million individuals across the country, Tricare is a widely used insurance provider for active duty service members, military members, veterans, and their family members.

If you receive Tricare health insurance and are looking for more information about substance abuse treatment through Tricare, read on to learn more.

Yes, Tricare insurance does cover drug and alcohol rehab. Of course, there are some limitations to this coverage and it may differ between plans.

Under the Affordable Care Act, all marketplace healthcare plans are required to cover certain aspects of substance abuse treatment.

These include:

• Behavioral health treatment
• Mental and behavioral health inpatient services
• Substance use disorder (SUD) treatment

That being said, it’s important to understand Tricare’s requirements as well as the details of your individual insurance plan.

There are many different types of treatment that provide different levels of care, and many can be tailored to the individual. Keep reading to learn a little bit about each kind of treatment and Tricare’s coverage policies.

Tricare covers a wide range of addiction treatment programs. Some common treatment services most facilities offer include medical detoxification, medication-assisted treatment (MAT), inpatient rehab, dual diagnosis treatment, outpatient treatment, counseling and behavioral therapy, and continuing care.

You’ll find coverage information and service details for each below.

Medical detox is a service that helps you get rid of any drugs or alcohol left in your system. This service is designed to not only purge the body of addictive substances, but also to manage withdrawal symptoms and monitor vitals/overall health.

Tricare covers detoxification for individuals with SUD through:

• Inpatient services (emergency and non-emergency)
• Intensive outpatient services (IOP)
• Partial hospitalization programs (PHP)
• Opioid treatment programs
• Office-based opioid treatment
• Residential SUD treatment

MAT is a kind of treatment that uses FDA-approved medications to treat SUD. It can lessen withdrawal symptoms and help ease the transition through addiction recovery.

MAT is covered by Tricare without pre-authorization in the following settings:

• Opioid treatment programs: if you have an opioid use disorder, require medically monitored detox, and need medical support, but not in a 24-hour setting.
• Office-based opioid treatment: as long as the provider follows Department of Health and Human Services, Drug Enforcement Agency, and state and local governments regulations.

Also known as residential treatment, inpatient treatment is a rehab service that offers 24/7 medical care and requires the individual to live in a designated facility throughout the course of treatment.

Tricare covers inpatient rehab but requires pre-authorization. Approval may be granted to those who are under 21 years old, have a primary diagnosis aside from SUD, are transitioning from another program as part of a treatment plan, are unable to function with only outpatient services, or are significantly impaired by their SUD.

Tricare also covers emergency inpatient treatment for individuals with SUD. Detox, stabilization, and any related medical complications are covered.

Addiction often occurs alongside mental health disorders such as anxiety, depression, or PTSD. These are known as dual diagnoses or co-occurring disorders. Dual diagnosis treatment addresses mental health issues alongside the physical obstacles of addiction.

Dual diagnosis treatment is typically offered in inpatient or outpatient settings, so Tricare coverage for a dual diagnosis will likely be contingent on the same parameters for those kinds of care.

Outpatient rehab can vary in level of care, but this kind of care allows the individual to remain living at home while receiving care at a designated facility on specific days or at specific times. PHP and IOP are variations of outpatient treatment you may be offered.

Outpatient coverage is a bit more complex, so it’s recommended to speak to a Tricare representative to fully understand your coverage parameters. While you won’t need pre-authorization for PHP, you may for IOP.

Counseling and behavioral therapy are vital parts of many addiction treatment programs. Individual counseling, group counseling, cognitive behavioral therapy (CBT), and dialectical behavioral therapy (DBT) are several common offerings.

Tricare covers both counseling and psychotherapy in inpatient and outpatient settings. Psychoanalysis is also covered if pre-authorized.

After completing an addiction treatment program, some people choose to continue certain services as they transition back to their day-to-day lives. This is known as continuing care and can include counseling, support groups, or even sober living facilities.

Sober living facilities fall under outpatient care with Tricare, so you may be able to get it covered. As far as other continuing care services, some (like support groups) don’t require fees while counseling and therapy are covered.

It’s important to remember there are several factors that Tricare coverage may be contingent on when it comes to addiction treatment.

Variables like your type of plan, your location, and the care you need. Your plan type will be the most indicative of your coverage levels due to several factors.

For example, your plan may require referrals or pre-authorizations for certain kinds of treatment. You also may need to pay copays or coinsurance, meet your deductible, or receive a particular diagnosis to receive coverage.

Tricare may cover a portion of the costs of out-of-network rehab programs. Out-of-network providers won’t accept Tricare and will not file claims with Tricare.

That being said, if you choose to see an out-of-network provider, you’ll most likely have to pay out of pocket for the full cost and file for reimbursement with Tricare — though this may not be complete reimbursement.

It’s best to receive care from in-network providers. If you’re unsure whether a rehab program accepts Tricare, don’t be afraid to call and ask.

Tricare offers a multitude of healthcare plans. Those which are available to you will depend on personal eligibility factors and where you live.

Tricare plans include:

• TRICARE Prime
• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
• TRICARE Select
• TRICARE Select Overseas
• TRICARE For Life
• TRICARE Reserve Select
• TRICARE Retired Reserve
• TRICARE Young Adult
• US Family Health Plan

The number of plans may be overwhelming, which is why Tricare offers a plan finder tool and a compare plans tool to help you find a plan suited for your needs and narrow down your options.

Drug and alcohol addictions are covered by Tricare insurance. There are many substances that can fall under this category.

Common substances that lead to SUD include heroin, meth, opioids, prescription drugs, cocaine, and benzodiazepines.

The bottom line is Tricare does not provide coverage based on the type of addiction, as long as it is alcohol or some kind of drug.

Finding rehab centers near you that accept Tricare can be easier than you may think. Many people become overwhelmed when looking for a treatment facility, which is why it’s important to know what tools you have at your disposal.

Treatment centers that accept Tricare can be found through Tricare’s “Find a Doctor” tool. This resource requires you to answer a few questions. It will then provide you with information about which providers you can see for care.

You can also call Tricare if you prefer to talk to someone about provider options. On the other hand, most facilities have accepted insurance information on their websites. You can also call the facility directly as well.

Receiving alcohol and drug addiction treatment at an affordable cost can be more realistic than you think. There are several treatment options that you may be able to get fully covered or at least partially covered.

If you or a loved one is considering addiction treatment, give our helpline a call today for additional guidance and advice.