Does TRICARE Cover Drug or Alcohol Rehab?
Substance use disorders in military veterans are a significant issue, with 1 in 10 veterans having a substance use disorder, which is higher than the average population rates in the US among civilians. In addition, around 30% of all active-duty service members engage in heavy drinking, and around 4% struggle with opioid use disorders, mainly from prescription opioids.1
What is Tricare Health Insurance?
Tricare is a health insurance program that covers active-duty military service members, retired service members, and their families. Tricare is administered by the Department of Defense and covers a variety of medical, mental health, and substance use disorders.2 If you or a loved one has a Tricare health insurance plan, and are in need of drug rehab, you may wonder if Tricare covers drug rehab. Tricare offers comprehensive coverage, and you can learn more about what coverage Tricare offers for substance abuse treatment on this page. You can also call the number on the back of your insurance card to get more information about your specific Tricare plan.
Tricare Insurance Drug Treatment Coverage
Tricare covers several types of drug rehab treatment, including both emergency and non-emergency treatment, detoxification, and ongoing support for rehab and recovery. The modalities of treatment covered by Tricare include:3,4
Inpatient Drug Treatment
- Inpatient treatment, which provides 24/7 treatment for those who are in need of this level of intensity. Inpatient treatment can include detoxification services.
Residential drug treatment
- Residential treatment, which is offered for those 21 and younger in need of long-term substance use treatment.
Outpatient Treatment Program
- Outpatient treatment, which is for those who do need to be hospitalized around the clock. Outpatient treatment can occur in individual sessions, with groups, or with your family. Outpatient treatment is usually in the form of intensive outpatient or partial hospitalization.
Intensive outpatient programs (IOPs)
- Intensive outpatient programs (IOPs), which are appropriate for people who do not require an around-the-clock rehab facility but need stabilization or for relapse prevention. IOPs can also be a step down from more intensive treatment.
Partial hospitalization programs (PHPs)
- Partial hospitalization programs (PHPs), which are programs that provide substance use treatment for people who have impairment in one or more areas of life but can function relatively well in other areas. PHPs can also provide management of withdrawal symptoms. A PHP can be a step-down from an inpatient program.
Medication-assisted treatment (MAT)
- Medication-assisted treatment (MAT), which provides medication and therapy to support people in need of opioid detoxification and ongoing support to manage an opioid use disorder. MAT for opioid use disorders can occur in different settings, including programs that take place through a doctor’s office.
Your specific need for any type of treatment will be determined after a thorough assessment, and this will help determine which of these types of treatment you need.
Does Tricare Cover Inpatient Mental Health?
Tricare also offers mental health services. These services run the spectrum from inpatient to outpatient services, which all depend on the needs of the individual and their current level of functioning. Tricare provides coverage for:4
- Outpatient therapy on an individual, group, or family basis.
- Intensive outpatient.
- Partial Hospitalization.
- Inpatient treatment.
- Residential treatment for persons under the age of 21.
Ideally, if you have both a mental health disorder and a substance use disorder, known as co-occurring disorders, a treatment program should treat both using an integrated approach. Studies have indicated that an integrated treatment program that addresses both types of disorders is superior in outcomes to programs that treat disorders separately.5
What Are The Different Types of Tricare Plans?
There is not just one Tricare plan, but a variety of coverage plans are offered to members. Your eligibility to participate in plans can depend on where you live, as well as whether you are retired, active duty, or a family member of a veteran or active-duty service member. These plans include:6
- Tricare Prime. This is a Tricare plan for active-duty service members. Prime also covers military veterans and families and is also available for those members of the National Guard who are activated, as well as their family members. Tricare Prime covers most types of substance use treatment, including inpatient, outpatient treatment, and detox.
- Tricare Prime Remote. This is a Tricare plan that is available for people who would otherwise qualify for Tricare Prime, but they live and work at least 50 miles from the nearest military hospital.
- Tricare Standard. This is another Tricare plan that is available for active-duty service members, as well as retired military members and their families. With Tricare Standard, members have more choice in terms of providers, but they will typically pay higher costs for these services. Tricare Prime and Standard are quite similar, but with Tricare Standard, there are authorizations that must be completed to approve certain services before a member can have these services covered.
- Tricare Standard Overseas. This is an option for both active duty and retired military service members and their families, and like Tricare Standard, it offers a wider choice of providers, but is also more expensive than Tricare Prime and also requires the same authorization procedures as Tricare Standard.
- For people who receive Medicare Part A and B, Tricare offers Tricare for Life, which offers coverage when Medicare coverage stops.
- Tricare Young Adult. This is another type of Tricare plan for those persons whoseTricare coverage has ended. A young adult is no longer eligible for their family Tricare plan after the age of 21 (23 if they are in college). Tricare Young Adult can provide coverage as long as the person is under the age of 26, unmarried, and is the child of a Tricare eligible member.
- Tricare Reserve Select. This is a plan that provides coverage for people who are in the military Reserves, but not on active duty. This plan is similar to a typical insurance plan with a deductible, monthly premiums, and a network of available covered providers. If you have Tricare Reserve Select, you can also go to an out-of-network provider, but the cost will be higher than for a network provider.
- Tricare Retired Reserve. This plan offers coverage for eligible retired reserve service members who are under the age of 60, as well as some surviving spouses of eligible retired reserve members. It is similar to Reserve Select in having deductibles, copays, and premiums, as well as the ability to see out-of-network providers, albeit at a higher cost.
Tricare Covered Drug Rehab
If you are interested in a specific treatment program, you can call and ask if they are in-network with Tricare. Or you can call the number on the back of your Tricare card to inquire about coverage. A program that you might want to know about is Desert Hope, a Tricare-covered rehab in Las Vegas, Nevada. Desert Hope offers a specialty treatment program for military veterans called Salute to Recovery. One of the important features of Salute to Recovery is that many of the staff members are military veterans themselves. You will be in a drug rehab program with other veterans who understand your experiences and what struggles you have as a veteran dealing with substance use disorders.
How to pay for drug treatment if rehab is not covered by Tricare?
If you want treatment at a rehab center that is not covered by your Tricare insurance policy, you will often pay a much higher price or even the full price of treatment. Some types of Tricare insurance plans do allow you to go out of network, as noted above, but you will pay a higher cost for these programs, rather than using a Tricare covered rehab program.
To cover these out-of-network costs, you can sometimes get a treatment scholarship from a drug rehab program, get a loan to finance treatment, put the costs on your credit card, or borrow from friends or family to pay for it. In some cases, you may be able to work out a payment plan over several months, but you may have to make a sizeable down payment upfront before going through treatment.
Regardless of where you decide to go for drug rehab, getting treatment right away, rather than waiting is important.
How To Find a Tricare-Covered Rehab?
If you or a loved one thinks that treatment for a drug abuse issue is needed, you can reach out today to speak with American Addiction Centers. By calling American Addiction Centers, we can quickly verify your insurance coverage and determine what coverage and benefits you are eligible for. You can do this by either clicking on the insurance verification form to see if you are covered, or you can call our 24/7 helpline to speak to a referral specialist who can check your benefits on the phone right now.