TRICARE Insurance Coverage For Opioid Abuse and Addiction Treatment Near Me

Does TRICARE Insurance Cover Opioid Rehab?

If you have a TRICARE insurance plan and are struggling with opioid addiction, you may be wondering whether your health plan covers opioid rehab. Under the Affordable Care Act (ACA), almost all health plans must cover mental health and substance use disorder treatment.¹ However, not every plan must offer the same levels of coverage. You may be limited to seeking care from in-network providers, and coverage may include various cost-sharing requirements (e.g., deductibles or copays).

The number of in-network rehab centers under your TRICARE plan will depend specifically on your health plan. To find a covered in-network facility near you, you can call the number on the back of your insurance card or work with a rehab facility directly. Learning more about your benefits and coverage can help you keep your healthcare costs low.

What Does TRICARE Insurance Cover for Opioid Treatment?

There are a total of 11 different TRICARE health plans that are offered to service members, veterans, and eligible dependents.² TRICARE is offered in all 50 states and other U.S. territories across the country, but that doesn’t mean that it is accepted at every rehab center across the nation.² It’s recommended that you verify your benefits and coverage by calling the number on the back of your insurance card.

Additionally, what your TRICARE plan covers in terms of opioid treatment may vary. Some of the common opioid treatments that may be recommended to you could include:

• Screenings and interventions. One of the first elements of opioid treatment is opioid use screening and intervention.³ In an opioid screening, a doctor assesses a patient’s opioid use or addiction to determine whether you have an addiction and whether treatment is right for you.³
• Detox. For those entering rehab for opioid addiction, you may need to undergo medically supervised detoxification.^{4, para 2} Detox involves ridding your body of substances like opioids.^{4, para 2}
• Inpatient. If you’re enrolled in inpatient opioid rehab, you’ll live at the facility for the duration of your rehab program, where you’ll receive 24/7 medically supervised care.^{5, (How are behavioral therapies used to treat drug addiction?)}
• Outpatient. If you’re enrolled in an outpatient opioid rehab program, you’ll attend treatment at a facility 1 or 2 times a week. Treatment could involve a group meeting or therapy.^{5, (How are behavioral therapies used to treat drug addiction?)}
• Behavioral therapies. Some aspects of opioid rehab involve behavioral therapies, which are methods that help engage patients in treatment. Behavioral therapies are designed to help patients get or remain sober and change their attitudes. They can also help teach patients skills to cope with the daily triggers of life without using opioids.⁶
• Treatment for co-occurring disorders. If you have a mental illness and substance use disorder, like opioid addiction, you may have a co-occurring disorder.^{7 “What should I do?”} While one isn’t proven to directly cause the other, the 2 conditions are often interconnected. As such, treating both at one time in an integrated treatment approach is often recommended. ^{7 “What should I do?”}

What TRICARE Insurance does Not Cover for Opioid Treatment?

Your TRICARE insurance plan may not cover the following elements for opioid treatment:

• Non-medical amenities
• Holistic care services
• Recreation programs
• Food delivery
• Private treatment services
• Alternative therapies

What is TRICARE Insurance?

TRICARE insurance has been around conceptually since the 1960s, but the more familiar versions of TRICARE were introduced in the 1990s.⁸ Today, TRICARE is a health insurance service for service members, veterans, and their dependents worldwide.⁸ Dental and pharmacy plans may also be offered to you through your TRICARE benefits. These plans are managed by the Defense Health Agency and the Department of Defense. As such, they meet the ACA’s minimum essential coverage requirements set forth by the federal healthcare reform law.⁸

Available to members all over the globe, TRICARE plans are managed in three global regions.⁹ There are 2 U.S. regions, called TRICARE East and TRICARE West, as well as a third overseas region.⁹ The overseas region covers Africa, Latin America, Canada, the Pacific area, and Eurasia.⁹ Where you are specifically located and what your military status is will dictate what health plan you may be eligible to enroll in through TRICARE.

How Much Does Opioid Rehab Cost?

How much opioid rehab costs under your specific TRICARE plan will depend on a multitude of factors. Specifically, the TRICARE plan you have, where you seek care, the amenities of the facility, and the type, intensity, and duration of treatment you receive will affect your overall rehab costs. If your TRICARE plan doesn’t fully or partially cover opioid rehab costs, you can ask the rehab facility if there are payment options, such as scholarships or financing options, available to you.

Cost of Inpatient Opioid Rehab

If you intend to use your Tricare plan for inpatient opioid rehab, your costs may vary. What you have to pay out of pocket for an inpatient rehab stay will depend on the TRICARE plan you have and what facility you attend.

How long you’re enrolled in an inpatient program, whether that facility is a luxury facility, and the services you receive will also influence your overall costs. Generally speaking, attending an inpatient rehab tends to be more expensive than an outpatient facility, as you’re receiving round-the-clock care, which can add up.

Cost of Outpatient Opioid Rehab

Although outpatient opioid rehab is often less involved than inpatient rehab, the overall cost of a program can range widely. How many sessions you attend weekly or bimonthly and whether the facility or provider is within your TRICARE insurance plan’s network play a large role in your overall costs. What’s more, the type of care you receive and whether there’s a limit on coverage can affect how much you end up paying.

Cost of Opioid Partial Hospitalization Programs (PHP)

Opioid partial hospitalization programs (PHPs) costs will vary. These programs, which are commonly called day programs, as patients spend a minimum of 4 hours per day, multiple days a week at treatment.^{10, Pg. 10, Para 2} Where you receive your PHP treatment and whether it’s a covered facility under your TRICARE plan will play a role in determining the cost of PHP care for opioid addiction.

Cost of Medication-Assisted Treatment (MAT)

Patients enrolled in opioid rehab may be referred for medication-assisted treatment (MAT).¹¹ MAT is often used in conjunction with behavioral or counseling therapies and involves a patient using prescription medication to address their dependency on opioids.¹¹ In those who participate in MAT, there may be a decreased need for detox.¹¹ Your TRICARE plan may provide coverage for the medications used in MAT, but there may be plan copays and tiers of coverage that affect your overall cost of care.

Opioid Rehab vs. the Cost of Opioid Addiction

Opioid addiction costs the U.S. economy $78 billion every single year.¹² Although the up-front costs of opioid addiction treatment may seem steep, the costs of untreated opioid addiction are potentially greater. Untreated addiction can lead to an increased risk of incarceration, lost income, and long-term health problems, such as heart disease, stroke, cancer, and mental illness.¹³

What Length of Opioid Rehab Does TRICARE Insurance Cover?

The length of opioid rehab covered by TRICARE insurance will vary based on the plan you have. Your policy may have specific details regarding how long it will cover opioid rehab, including variances in how it treats different types of care. Looking up your insurance information on the back of your TRICARE card may give insight into your plan details. You can also call the number on your card to speak to a TRICARE representative who can give you more information.

Even though your plan may only cover a specific amount of time for opioid rehab treatment, it’s important to prioritize staying in rehab for as long as your provider recommends. Contingent upon positive outcomes of rehab is remaining in treatment for a long enough time.¹⁴

Treatment should last at least 3 months (or 90 days) in order for patients to have positive outcomes and reduce or stop their opioid or drug use.¹⁴ Please remember that all paths to recovery are different, so you should work with your mental health professional to determine what is best for you.

Choosing Between TRICARE Insurance Inpatient vs. Outpatient Opioid Rehab Centers

When enrolling in treatment, you may be asked to choose between inpatient versus outpatient opioid rehab centers. Your decision should be made with the help of your mental health professional or team of professionals.

In inpatient care, you may find a specific treatment ecosystem, support system, and a more focused environment, as you’ll be living at the facility for the duration of your care. Outpatient care isn’t a lower quality of care, but it may require you to have higher self-accountability, as you’ll be receiving treatment at a lesser frequency than inpatient care. As you work with your provider, you’ll be able to determine what setting might be right for you.

How To Use TRICARE Insurance for Opioid Rehab

Using your TRICARE insurance for opioid rehab may seem complicated, but it’s rather straightforward. You’ll begin the process by consulting a doctor for opioid use or misuse. Then, they will help you find a suitable rehab program and may even help you determine your ability to use insurance at the program.

If you need to determine the acceptance of your plan at the treatment center, you can do so by calling the number on the back of your card or by reaching out to the rehab center directly. As you get care from the facility, the rehab center will bill your insurance, and then you may be asked to provide your portion of the bill, as well as any cost-sharing measures, like copays or coinsurance.

How To Find Opioid Rehabs That Accept TRICARE Insurance

If you or a loved one is struggling with opioid addiction and has a TRICARE insurance plan, you may be wondering how you can find opioid rehabs near you that accept your plan. American Addiction Centers (AAC) is here to help you do just that. AAC staff is trained to help you at every step of the way.

Call our confidential opioid helpline today to have a real person check your benefits while you’re on the phone and help you locate a nearby treatment center. AAC has leading treatment centers nationwide, and some may even accept Tricare insurance.

You can also speak with a mental health professional today to discuss your opioid rehab treatment options. By either calling the helpline or reaching out to a provider today, you’re taking an important step toward your future of overcoming opioid addiction. Don’t wait any longer; reach out to get coverage today.