Tricare Insurance

Tricare insurance

If you or a loved one needs addiction or mental health treatment and have TRICARE, you are eligible for a wide range of coverage. Of course, TRICARE benefits aren’t automatic and need approval first. TRICARE plans may cover:

What is TRICARE Insurance

TRICARE, formerly the Civilian Health and Medical Program of the Uniformed Services, is supplemental healthcare for active and retired military and their families. It is also a program of the United States Department of Defense Military Health System. TRICARE covers individuals of:

  • Air Force
  • Marines
  • Army
  • Navy 
  • Marine Corps
  • Coast Guard
  • Commission Core
  • Public Health Service
  • Commission Core of the National Oceanic and Atmospheric Association

In 2017, TRICARE made big changes to its mental health benefits. It now covers addiction treatment. This expansion includes therapy for opioid addiction and other substance use disorders (SUD). Drug and alcohol use and mental health issues are an ongoing issue with active and retired military members. 

Many factors determine treatment, including:

  • Individual plan details
  • Where a person lives
  • Type of treatment
  • Legal requirements

Health Plans Available with TRICARE

Like all health insurance plans, there are options for those with TRICARE coverage. All plans meet or exceed the Affordable Care Act (ACA) standards. These standards ensure quality health insurance to meet people’s needs. 

Each plan has specific things it does and doesn’t care. TRICARE offers eight health insurance plans.

  • TRICARE Prime provides coverage to geographical ‘prime’ locations in the U.S.
  • TRICARE Prime Remote provides coverage in more remote locations in the U.S. and overseas.
  • TRICARE Standard and Extra requires a paid fee but not enrollment for members to receive treatment.
  • TRICARE Standard Overseas provides full coverage for those overseas.
  • TRICARE for Life is a Medicare option for people with Medicare Part A and B.
  • TRICARE Reserve Select is a premium-based plan. It provides coverage for qualifying members and their families.
  • TRICARE Retired Reserve is a premium-based plan. It provides coverage for retired members under 60 and their families.
  • TRICARE Young Adult provides coverage for young adult children that don’t qualify for other TRICARE options. 

The specifics of coverage depends on a person’s service and qualifications.

What Does In-Network Mean?

TRICARE generally only offers full coverage to select providers. These in-network providers have a pricing agreement with TRICARE for addiction and mental health treatment. However, in an in-network treatment center, members pay a small portion of the cost out-of-pocket. 

What does Out-of-Network Mean?

Some TRICARE plans offer coverage of out-of-network providers. However, members may have to pay all costs upfront and file a claim for payment. Out-of-network treatment can cause members to pay a higher portion of the cost. 

Does TRICARE Cover Mental Health Treatment?

In short, yes. TRICARE covers mental health treatment. In most cases, pre-authorization is not required. But for some outpatient treatments, a referral may be needed. Active duty service members are urged to seek non-emergency health care when available. 

Common mental health issues in service members include:

  • Anxiety
  • Depression
  • Adjustment disorder
  • Alcohol Dependence
  • Bipolar disorder
  • Post-traumatic disorder (PTSD)
  • Psychosis
  • Substance Use Disorder (SUD)

Does TRICARE Cover Detox and Withdrawal Management?

Detox is the first step to recovery. Medical detox helps people safely rid their bodies of substances. Also, a detox program can give medications to ease the pain of withdrawal. TRICARE covers detox and medication management of withdrawal symptoms. However, detox must be followed by inpatient or outpatient treatment. 

Does TRICARE Cover Addiction Therapy

Members with TRICARE insurance are eligible for a range of addiction treatments. From detox to medication-assisted therapy, TRICARE covers most addiction treatments. For this reason, TRICARE coverage allows members to seek the treatment needed to find Recovery for LIfe. 

Covered Treatments

TRICARE covers psychological and medically necessary substance use and mental health disorders. This includes inpatient and outpatient services. 

  • All Mental Illnesses (AMI)
  • Applied Behavior Analysis
  • Autism Spectrum Disorder
  • Cognitive Therapy
  • Continuing care therapy
  • Drug testing
  • Eating Disorders
  • Electroconvulsive therapy
  • Family therapy
  • Gender dysphoria
  • Intensive outpatient programs
  • Detox
  • Medication-assisted treatment
  • Office-based opioid therapy
  • Opioid treatment programs
  • Partial hospitalization
  • Psychanalysis
  • Psychological testing
  • Psychotherapy
  • Substance use disorder
  • Therapeutic services

TRICARE also covers alternative therapies in inpatient treatment. They include yoga, art therapy, equine therapy.

What’s the Difference Between Inpatient and Outpatient Coverage?

TRICARE covers inpatient or residential treatment if members meet certain conditions. The conditions include a formal diagnosis, withdrawal symptoms requiring assistance, issue impairs daily life. If the conditions are met, TRICARE covers both emergency and non-emergency inpatient treatment. 

Emergency treatment is when a medical or psychiatric crisis occurs. TRICARE covers the costs of detox, stabilization, and medical complications. Non-emergency treatment is when a person seeks therapy on their own. This treatment needs prior-authorization from TRICARE. Detox and stabilization are covered as well as co-occurring mental health issues. 

TRICARE also covers outpatient treatment. But, only if specific qualifications are met. Coverage requires a person to be actively using drugs or alcohol and not need 24/7 care. 

TRICARE covers different types of outpatient treatment. They include outpatient, intensive outpatient (IOP), or partial hospitalization programs (PHP). Outpatient treatment offers the same programs as inpatient treatment without living in a facility. 

Does TRICARE Cover Medication-Assisted Treatment?

TRICARE covers medication-assisted treatment for members with opioid use disorder (OUD) or alcohol use disorder (AUD). TRICARE covers mental health therapies along with the medications to prevent withdrawal and relapse. 

TRICARE also covers opioid treatment programs. The misuse of opioids is a growing problem across America. The opioid crisis impacts many people. But, the situation also affects active duty and retired service members and their families. TRICARE covers both medication and behavioral therapies in opioid use disorder. 

TRICARE may not require prior authorization for medication-assisted treatment when using an in-network provider. For a center to qualify to administer medication-assisted treatment, they must be authorized by the Drug Enforcement Agency (DEA). 

Does TRICARE Cover Recovery Housing?

Recovery housing may be covered under TRICARE’s PHP coverage. Recovery housing allows members to receive treatment for substance use disorder (SUD) while encouraging recovery. Also, recovery housing helps develop relapse prevention skills. 

Members must have an inability to reach and maintain recovery without outpatient treatment. For instance, the impairment from addiction must interfere with daily life. If all the requirements are met, TRICARE will cover recovery housing through PHP coverage. 

Does TRICARE Cover Telemedicine?

TRICARE covers using secure video conferencing for necessary services. Secure connections can be made through computers or cell phones. Services include:

  • Individual therapy
  • Mental health assessments and diagnosis
  • Medication management

Depending on a person’s TRICARE plan, they may need a referral or prior authorization. Active duty service members seeking telehealth will need a referral. 

Due to Coronavirus, TRICARE has revised the telehealth policy. However, the changes are temporary. TRICARE will now:

  • Cover audio-only telehealth visits.
  • Waive co-payments and cost-shares for all covered telehealth services at approved facilities.
  • Allow more providers to offer telehealth services.
  • If a person lives overseas, telehealth has to be legal.

Does TRICARE Pay for Entire Recovery Treatment?

According to TRICARE’s website, they pay for emergency and non-emergency inpatient treatment. Treatments include residential SUD treatment and PHP. However, it’s crucial for people always to check their policy first. 

TRICARE typically covers:

  • Psychological assessments
  • Psychoeducation
  • Individual therapy
  • Group therapy
  • Medication-assisted treatment
  • Holistic therapies
  • Continuing care appointments
  • Opioid treatment programs
  • Family therapy
  • Cognitive-behavioral therapy

The Scope of Addiction in Service Members

According to the National Institute on Drug Abuse, uniformed and retired service members are at risk of addiction. For example, the stress of deployment and military life culture can increase SUD and mental health issues. 

Stigmas around addiction still exist. Despite making changes, many service members are afraid to seek help. However, drug use in service members is lower than the general public. Yet, binge drinking and prescription drug misuse are higher.

The Department of Defense (DOD) has policies for all aspects of SUD. They provide education and awareness, medical testing, and evidence-based therapies. Additionally, after SUD treatment, active members return to duty. 

The DOD provides drug education and prevention to each service member. Additionally, each military service operates its substance use program. The military also offers a medication take-back program. This program eliminates those battling addiction from using leftover drugs. 

Finding TRICARE Approved Treatment Centers

There are many ways to find a treatment center that works with TRICARE. To begin with, a person can call TRICARE and ask for centers near them. Another way is to check the TRICARE website. Lastly, a person can call a treatment center such as Sana Lake and ask if they take TRICARE.

Finding Recovery at Sana Lake 

No one has to battle addiction or mental health issues alone. Sana Lake offers “whole person” treatment to service members and the general; public. What are you waiting for? Contact us today and start your journey to Recovery for LIfe!

References:

https://www.tricare.mil/CoveredServices/IsItCovered/SubstanceUseDisorderTreatment

https://www.tricare.mil/mentalhealth

https://www.tricare.mil/CoveredServices/IsItCovered/MentalHealthTherapeuticServices

Article Reviewed by David Sherman, MD

David Sherman, MDDavid Sherman, MD is a Fellow of the American Society of Addiction Medicine (FASAM) and board certified in Addiction Medicine with the American Board of Preventive Medicine. He is a native Missourian and graduated medical school at the University of Missouri-Columbia School of Medicine. Dr. Sherman completed a two-year fellowship in Addiction Medicine at the University of Florida in Gainesville. He leads a highly trained staff of master level certified addiction professionals. Men and women from all over Missouri and the United States come to Sana Lake Recovery Center to get the care they need and deserve.