TRICARE Health Coverage for Addiction Treatment

If you’re in the American Armed Forces, there’s a good chance you have TRICARE. You may also have TRICARE if you served in the past or if you’re a family member of someone who served or is serving. You can use TRICARE the same way you would use health insurance. The funding for your TRICARE benefits comes from the Department of Defense.

TRICARE’s plans provide coverage for medical and pharmacy benefits. You can also get dental and vision from them too. Most services will be covered by the medical benefit. The pharmacy benefit will cover medications that your provider prescribes to treat you.

Does TRICARE Cover Addiction Treatment?

If you’re on active duty, the first stop for help with substance use is your local military hospital. Your primary care manager, also known as a PCM, can give you the referrals you need and request prior authorization if needed.

All VA health systems are equipped to handle all levels of substance use treatment, including residential or inpatient treatment. TRICARE does contract with some addiction treatment centers outside of the VA system, but to go to an outside provider, you’ll first have to get prior authorization.

If you’re not on active duty but still have TRICARE coverage, such as a military spouse, you’ll also need prior authorization for drug rehab if your condition isn’t an emergency. Your primary care provider can refer you and request prior authorization on your behalf.

If you’re retired and have TRICARE for life, you can go anywhere that takes Medicare since that’s your primary payer.

Does TRICARE Cover Suboxone & Methadone (MAT)?

Medication assisted treatment (MAT) combines mental health therapies and prescription drugs to treat substance use disorders. Suboxone and methadone are two of the FDA approved drugs used for MAT.

The medications and therapy are covered if you have medical need for this treatment and the TRICARE authorized provider is certified by the DEA to prescribe the medications. You may attend individual and group sessions in addition to regular doses of approved medications.

Does TRICARE Cover Other Mental Healthcare?

TRICARE offers coverage for a variety of medically necessary mental and behavioral health services for military personnel and their family members. However, these services may require a referral or preauthorization. Always contact your TRICARE provider before you see a mental health specialist to confirm coverage.

Covered treatments include applied behavior analysis, autism spectrum disorder, and cognitive rehabilitation therapy. You can also get coverage for eating disorder treatment, emergency inpatient hospitalization, and substance use treatment.

Many times people who struggle with substance use have a mental health diagnosis at the same time, known as a co-occurring disorder. It’s important to treat both your mental health and substance use in an integrated way. TRICARE offers programs that specialize in that and your doctor can point you in the right direction.

What Types of Plans Does TRICARE Offer?

There are multiple TRICARE plans and understanding your specific plan is vital to ensuring you get the care you need.

TRICARE Prime is a managed care network. It’s only available in certain areas, usually near a military base. If you’re on active duty, you must use TRICARE Prime as your plan. With this plan, you’ll have to stay within the TRICARE network to get your treatment covered.

You’ll also need a referral from your primary care manager for most specialists including for outpatient substance use treatment.

TRICARE Select is a PPO, or preferred provider organization. This means that you can use TRICARE for authorized non network providers in addition to their preferred in network providers.

However if you stay within their preferred provider network they’ll cover a higher percentage of the cost which is less out of your pocket. Select may have higher premiums than the TRICARE Prime plan but gives you more care options.

You don’t need to get a referral for specialist care when you have Select. But, you’ll still need a referral for residential drug rehab.

If you’re able to get Medicare, TRICARE for Life is the plan that’s available to you. It’s like a supplement to Medicare. With it, you can go to any place where they accept Medicare. TRICARE kicks in for certain things that Medicare doesn’t cover or if a benefit runs out.

What Outpatient Rehab Does TRICARE Cover?

You can definitely get outpatient substance use treatment if you have TRICARE, but how you access this treatment will vary based on what type of TRICARE plan you have. If you’ve TRICARE Prime, you’ll need a referral from your primary care manager. If you have TRICARE Select, you won’t need a referral for most outpatient services.

Outpatient programs can be intensive such as partial hospitalization programs or intensive outpatient programs, which include 10-20 hours of treatment per week. General outpatient generally meets 1-3 hours per week. In each case, you’ll live at home or in a sober living facility outside of treatment.

Outpatient services include options like psychotherapy for individuals, group sessions and family therapy. Psychological testing and analysis may also be a covered benefit, along with treatments such as art therapy and music therapy along with occupational therapy.

Medication assisted treatment (MAT) may be covered as well. MAT uses FDA approved medication to help you manage cravings and stay stable during treatment. This allows you to lay a strong foundation for recovery with a lower risk of relapse.

What Inpatient Addiction Treatment Does TRICARE Cover?

TRICARE covers certain inpatient alcohol and substance use disorder treatment as long as it is deemed medically necessary.

Medical detox can be the first step for many people who are ready to break free from substance use. Detox is usually a week or less, but it’s an inpatient process so you can be monitored and treated for withdrawal symptoms. Medical detox allows the substances to leave your system while keeping you safe and as comfortable as possible.

TRICARE may also cover inpatient treatment that isn’t an emergency, which can help you get the care you need to move toward recovery. There are requirements that must be met, like having symptoms severe enough to need medical help, having a formal substance use disorder diagnosis, and struggling to function in everyday life. You also need to use a TRICARE authorized institutional provider.

Inpatient treatment services that are not an emergency generally need preauthoritzation.

What to Do if TRICARE Won’t Cover the Cost of Rehab

Most of the time, you’ll be able to find a treatment plan that TRICARE covers. However if you are looking for treatment that’s not in the provider network or you haven’t met the requirements coverage might be denied. The best thing to do is work with TRICARE to find a facility that meets your needs.

If you are not able to do this, youcan work with the treatment center to create a payment plan. Some centers also offer scholarships to those who need it. You can even apply for health credit such as CareCredit to pay the amount off over time. Finally you can find low cost or free treatment offered by nonprofits or your local community. Resources for these services can be found on SAMHSA website at SAMHSA.GOV.