More About Rehabs Accepting Tricare
About TRICARE
TRICARE provides high quality health insurance plans worldwide for active and retired U.S. military personnel and their families(1). With both military and civilian networks, members can access care for a variety of health-related concerns, including substance use disorders(1,2). If you are struggling with substance misuse or addiction and are looking for professional help, some or all of your treatment costs could be covered by TRICARE(2). Keep reading to learn more about TRICARE coverage for rehab and how to start your journey to recovery.
This page is intended to be a general overview of how TRICARE covers addiction and mental health services, not a comprehensive guide on the subject. For specific questions about your TRICARE plan and coverage for addiction treatment, call a TRICARE representative directly and learn more about paying for rehab.
TRICARE Plan Options
TRICARE, like most health insurance companies, offers coverage for substance abuse treatment. This can include inpatient and outpatient treatment, counseling, and medication-assisted treatment.
The specific details of TRICARE's substance abuse coverage will depend on your specific plan. You can contact TRICARE directly or look at your plan's coverage details online to learn more about the substance abuse services it covers. Their 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 availability of each plan depends on where you live and your military status. TRICARE covers most costs for approved services, including inpatient and outpatient behavioral health services.
TRICARE and Medicare
TRICARE plans cover leftover costs after Medicare is applied. Medicare is the federal health insurance program for people 65 or older and people with certain disabilities.
The specifics of what is covered by TRICARE after Medicare will vary depending on your plan and the state you live in. You can look at your plan's coverage details or contact TRICARE directly to find out more.
Does TRICARE Cover Drug and Alcohol Addiction Treatment?
TRICARE provides coverage for drug and alcohol addiction treatment, however the amount of coverage a person receives typically depends on the type of plan they have(2). Under the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), insured individuals receive coverage for substance use disorders and mental health services to the same extent that they would physical health conditions(3,4). Additionally, ACA marketplace insurance plans must cover essential health benefits, including addiction and mental health care(5).
That said, the type and amount of coverage you have through your plan may vary(5). Speaking with your insurance provider can help you understand vital details about your policy and the amount of TRICARE coverage you may receive for addiction treatment. To find a rehab that accepts TRICARE insurance, you can ask your TRICARE representative about your plan’s benefits and limitations, potential out-of-pocket costs, and in-network providers.
Addiction Treatment Options
Since recovery is unique for everyone, multiple levels of addiction treatment are available to meet your needs as you end your active substance use for good(6). TRICARE may partially or fully cover several levels of care based on your specific insurance plan and medical necessity(2). Some of these include the following.
TRICARE for Medical Detox
TRICARE typically covers medically supervised detox programs, which involve the use of medication and other treatments to help people manage the physical and emotional symptoms of withdrawal from drugs or alcohol. TRICARE may also cover the cost of inpatient or residential detox programs, providing more intensive care and support.
TRICARE and Medically-Assisted Treatment
MAT is a form of rehab that combines medication with therapy to help those recovering from addiction. TRICARE insurance covers many forms of MAT, including methadone and buprenorphine.
TRICARE Coverage for Residential Treatment
Inpatient treatment is the most intensive form of rehab , and it typically involves staying at the center for several weeks or months. Inpatient treatment is ideal for those with severe addiction or mental health issues. Your TRICARE insurance plan may cover a significant portion of treatment costs; check with a TRICARE representative to see how much.
TRICARE Coverage for Co-Occurring Disorder Treatment
TRICARE may cover co-occurring disorders to some extent, depending on your policy(7). Many people experiencing SUD also battle mental health conditions, like depression, anxiety, or post-traumatic stress disorder (PTSD)(6). Mental health professionals recommend treating co-occurring disorders in tandem for the most positive outcomes(6).
How to Use TRICARE for Addiction Treatment & Rehab
Using TRICARE for addiction treatment starts with understanding your coverage. Speaking with your provider can help you gather information about your plan. TRICARE offers different ways to check your benefits and learn more about your policy:
- TRICARE Patient Portals: Visit the TRICARE website to view the All Logins page. Click on the link for your specific region or plan. You can access an explanation of your plan’s benefits and limitations here.
- Humana Military app: TRICARE provides a mobile app for East Region beneficiaries to check service eligibility from their phone.
- Contact member services: Call the number on the back of your insurance card to speak with a representative about your benefits and learn more about your TRICARE coverage for rehab.
Start Your Recovery
Professional addiction treatment can give you the tools to address the underlying causes of addiction and develop healthy coping skills that keep you in long-term recovery(6). Starting the recovery process can be overwhelming, but there are several opportunities for support and encouragement available so you can find the help you need. If you or a loved one is ready to seek rehab for a substance use disorder, explore your options and reach out to a rehab center using our rehab directory tool today!
TRICARE Rehab Coverage FAQs
Does TRICARE insurance cover drug and alcohol rehab?
TRICARE insurance may cover drug and alcohol rehab, but the coverage depends on your insurance plan and policy. TRICARE plans typically have benefits for addiction treatment, including inpatient and outpatient rehab, counseling, and therapy.
How can I verify my TRICARE insurance benefits?
You have several ways to verify your TRICARE insurance benefits:
- Check your insurance card: Your TRICARE insurance card will typically contain information about your plan, including your copayment amounts, deductibles, and the services covered by your plan.
- Log into your online account: If you have an online account with TRICARE, you can log in to view your insurance information , including your coverage details, claims history, and copayment amounts.
- Contact customer service: You can call TRICARE’s customer service department to speak with a representative who can provide information about your coverage, including what services are covered and what your out-of-pocket expenses may be.
- Check your plan's summary of benefits: TRICARE provides a summary of benefits for each of its insurance plans, which you can view online or request a printed copy of. The summary of benefits provides an overview of your plan's coverage, including what services are covered, what your out-of-pocket expenses may be, and any limitations or exclusions that apply.
- Ask your healthcare provider: If you have any questions about your coverage, you can also ask your healthcare provider. They may be able to provide information about what services are covered by your TRICARE insurance plan and what your out-of-pocket expenses may be.
Does TRICARE cover outpatient addiction treatment?
TRICARE typically covers a range of outpatient treatments for substance abuse, including individual and group therapy, medication-assisted treatment, and support groups. Coverage may also include access to a network of licensed mental health and addiction specialists.
Does TRICARE cover inpatient drug and alcohol rehab?
Yes, TRICARE insurance plans typically cover the cost of inpatient drug and alcohol rehab. The extent of coverage for inpatient rehab will depend on the specific TRICARE insurance plan you have and any exclusions or limitations that apply to that plan.
Does TRICARE cover inpatient mental health?
Yes, TRICARE insurance plans typically cover inpatient mental health treatment for conditions such as depression, anxiety, and other mental health conditions. The extent of coverage will depend on the specific TRICARE insurance plan you have and any exclusions or limitations that apply to that plan.
Do treatment centers need to be In-Network?
TRICARE insurance plans may cover out-of-network rehab, but the specific coverage will depend on the individual's insurance plan and policy. Some TRICARE plans have out-of-network benefits that allow members to receive coverage for services from providers outside the plan's network. However, this coverage is usually lower than in-network coverage, and members may have to pay more out-of-pocket costs.
How much does TRICARE insurance cover?
The amount that TRICARE insurance covers will depend on several factors, including:
- The type of insurance plan you have: TRICARE offers a range of insurance plans with different levels of coverage and benefits. How much you pay will vary depending on your plan.
- The type of health service you need: TRICARE insurance plans typically cover a range of health services, including preventive care, doctor visits, hospital stays, and prescription drugs. However, the specifics of what is covered and to what extent will vary depending on your plan.
- Your annual deductible: A deductible is the amount you pay out-of-pocket each year before your insurance begins to cover the costs of your care. Deductibles can vary depending on your insurance plan and the type of care you need.
- Your copayments and coinsurance: In addition to a deductible, you may also be responsible for copayments (a set amount you pay for a service) and coinsurance (a percentage of the cost of a service you pay).
It’s important to note that TRICARE insurance plans may also limit the coverage available for certain types of services or treatments. To find out how much your TRICARE insurance plan covers, you can look at your plan's coverage details or contact TRICARE directly .
How do I pay for costs not covered by TRICARE insurance?
If you have received health services not covered by your TRICARE insurance plan, you may be responsible for paying for those costs out of pocket. There are several options for paying for these costs, including:
- Paying directly: You can pay the healthcare provider directly for the costs not covered by your insurance plan.
- Using a health savings account (HSA) or flexible spending account (FSA): If you have an HSA or FSA, you may use these tax-advantaged accounts to pay for out-of-pocket healthcare expenses.
- Applying for financial assistance: Depending on your financial situation, you may be eligible for financial assistance from the healthcare provider or a government program.
- Negotiating with the healthcare provider: In some cases, you may be able to negotiate a payment plan with the healthcare provider to help make the costs more manageable.
The options available to you will depend on the type of healthcare services you receive, the cost, and your financial situation. If you have questions about paying for costs not covered by your TRICARE insurance plan, you may want to contact TRICARE or the healthcare provider directly.
How is a TRICARE HMO different from a PPO?
TRICARE HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) are both types of health insurance plans offered by TRICARE, but they differ in how they handle healthcare providers and costs.
In a TRICARE HMO, you typically choose a primary care physician (PCP) who acts as a gatekeeper to the healthcare system. To see specialists or receive treatments, you usually need a referral from your PCP. Additionally, HMOs usually have a smaller network of healthcare providers, and you may need to pay more if you receive care outside of the network.
In a TRICARE PPO, you can choose healthcare providers without needing referrals. PPOs often have a larger network of healthcare providers, but you may need to pay more if you receive care outside of the network.
Regarding costs, HMOs often have lower monthly premiums and out-of-pocket costs than PPOs. However, with a PPO, you may have more flexibility in choosing your healthcare providers, which can be an advantage if you value having more control over your healthcare decisions.
When choosing between a TRICARE HMO and PPO, consider your individual needs and preferences. You can also compare the features and costs of different plans to determine which plan is the best fit for you.
Can you get a single case agreement with TRICARE?
Yes, it is possible to request a single case agreement (SCA) with TRICARE for coverage of a specific medical treatment or procedure (such as inpatient drug and alcohol rehab) that is not otherwise covered by your insurance plan. An SCA is a request for a one-time exception to TRICARE's usual coverage policies.
To request an SCA with TRICARE, you must typically provide medical documentation to support your case and demonstrate that the treatment or procedure is medically necessary. TRICARE will then review your request and determine whether to grant the SCA.
SCAs are not guaranteed and are subject to TRICARE approval. Additionally, the decision to grant an SCA is based on several factors, including medical necessity, cost, and alignment with TRICARE's coverage policies.
If you are interested in requesting an SCA with TRICARE, you can contact their customer service department to learn more about the process and what information you will need to provide.
Sources
- TRICARE. (2023, August 24). TRICARE 101.
- TRICARE. (2018, October, 3). Substance use disorder treatment.
- Healthcare.gov. (n.d.). Affordable Care Act (ACA).
- Centers for Medicare & Medicaid Services. (2024, September 10). The Mental Health Parity and Addiction Equity Act (MHPAEA).
- Healthcare.gov. (n.d.). Health benefits & coverage.
- National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (third edition).
- TRICARE. (2022, March 20). Mental health therapeutic services.