What Is Tricare?

Tricare is the healthcare program for military personnel, retirees, and their families. It provides comprehensive coverage for a range of medical services, including mental health and substance abuse treatment. However, the extent of coverage for alcohol and drug rehab can vary depending on the type of Tricare plan you have and the specific treatment you need.

Tricare's Main Plans

Tricare offers three main plans: Tricare Prime, Tricare Select, and Tricare for Life. Each plan has different rules and requirements for substance abuse treatment. Here is a breakdown of what you can expect from each plan:

Tricare Prime

This plan is available to active-duty service members, their families, and retirees. If you are enrolled in Tricare Prime, you can receive substance abuse treatment through your primary care manager (PCM).

Your PCM will refer you to a specialist if necessary. Tricare Prime covers both inpatient and outpatient treatment for substance abuse, but there may be some out-of-pocket costs depending on the specific treatment you receive.

Tricare Select

This plan is available to active-duty service members, their families, and retirees. Tricare Select is a fee-for-service plan, which means you may have to pay a deductible and copayments for substance abuse treatment. However, Tricare Select covers both inpatient and outpatient treatment for substance abuse.

Tricare for Life

This plan is available to military retirees who are eligible for Medicare. Tricare for Life covers substance abuse treatment that is covered by Medicare, but there may be some out-of-pocket costs depending on the specific treatment you receive.

It's important to note that Tricare may not cover all types of substance abuse treatment. For example, Tricare does not cover wilderness therapy or equine therapy for substance abuse. Additionally, Tricare may require pre-authorization for certain types of treatment, such as residential treatment programs.

Different Types of Substance Abuse Treatment Available Through Tricare

Tricare covers a range of substance abuse treatments, including individual and group therapy, detoxification programs, inpatient and outpatient rehabilitation programs, and medication-assisted treatment (MAT).

Individual and group therapy: These types of therapies are often used as part of an outpatient treatment program. They can help individuals understand the underlying causes of their addiction and develop coping mechanisms to prevent relapse.

Detoxification programs: This type of treatment is typically used at the beginning of a substance abuse program. It involves removing harmful substances from the body in a safe way. Detoxification can be done on an outpatient or inpatient basis.

Inpatient and outpatient rehabilitation programs: These programs provide comprehensive care for individuals who are struggling with addiction. Inpatient programs require patients to live at the facility for a set period of time while they receive intensive treatment. Outpatient programs allow patients to continue living at home while receiving regular treatment sessions.

Medication-assisted treatment (MAT): MAT is a combination of medication and behavioral therapy that can be used to treat opioid, alcohol, and nicotine addictions. Medications such as methadone, buprenorphine, and naltrexone are often used as part of MAT.

It's important to note that not all types of substance abuse treatment will be covered by Tricare. For example, wilderness therapy or equine therapy may not be covered. Additionally, some types of treatment may require pre-authorization before coverage kicks in. It's always best to check with your provider or Tricare representative to determine what treatments are covered under your specific plan.

How to Find a Provider Who Accepts Tricare

Finding a provider who accepts Tricare for substance abuse treatment can be a daunting task, but there are resources available to help you. One of the easiest ways to find a provider is by using the Tricare provider search tool on their website. This tool allows you to search for providers in your area who accept Tricare.

You can also contact your regional contractor or Tricare customer service representative for assistance in finding a provider. They can provide you with a list of providers in your area who accept Tricare and answer any questions you may have about coverage.

It's important to note that not all providers who accept Tricare may offer substance abuse treatment, so it's important to verify that the provider offers the specific type of treatment you need before scheduling an appointment. Additionally, some providers may require pre-authorization from Tricare before beginning treatment, so be sure to check with both the provider and Tricare beforehand.

Overall, finding a provider who accepts Tricare for substance abuse treatment may require some research and legwork, but it's worth it to ensure that you receive high-quality care covered by your insurance plan.

Managing the Cost of Substance Abuse Treatment with Tricare

While Tricare offers comprehensive coverage for substance abuse treatment, there may still be some out-of-pocket costs associated with your care. Here are some tips to help you manage the financial costs of substance abuse treatment with Tricare:

1. Understand Your Benefits: Before beginning any substance abuse treatment, it's important to fully understand what is covered under your specific Tricare plan. This will help you anticipate any out-of-pocket expenses and plan accordingly.
2. Consider In-Network Providers: When possible, try to choose an in-network provider for your substance abuse treatment. In-network providers have agreed to accept a negotiated rate from Tricare, which can help reduce your overall costs.
3. Look for Sliding Scale or Reduced-Fee Programs: Some substance abuse treatment providers offer sliding scale or reduced-fee programs based on income or other factors. These programs can help make treatment more affordable.
4. Check for Discounts: Some substance abuse treatment providers offer discounts to military personnel and their families. Be sure to ask about any available discounts when choosing a provider.
5. Use Flexible Spending Accounts (FSAs): If you have access to an FSA through your employer, consider using it to pay for any out-of-pocket expenses related to your substance abuse treatment.
6. Seek Help from Military Support Organizations: There are many military support organizations that offer financial assistance for substance abuse treatment, including the Navy-Marine Corps Relief Society and the Air Force Aid Society.
7. Talk to Your Provider About Payment Plans: If you are unable to pay for your substance abuse treatment upfront, talk to your provider about setting up a payment plan that works for you.

By following these tips and taking advantage of all available resources, you can manage the financial costs of substance abuse treatment while still receiving high-quality care covered by Tricare.

Common Misconceptions About Tricare Coverage for Substance Abuse Treatment

Despite the comprehensive coverage provided by Tricare for substance abuse treatment, there are still some common misconceptions about what is covered and how to access care. Here are a few misconceptions to be aware of:

1. Tricare only covers substance abuse treatment for active-duty service members: While it's true that active-duty service members can receive substance abuse treatment through Tricare, the program also provides coverage for military retirees and their families.
2. Only inpatient treatment is covered: While inpatient treatment is covered under all Tricare plans, outpatient treatment is also covered. In fact, many individuals find that outpatient treatment is more flexible and allows them to continue working or attending school while receiving care.
3. Pre-authorization isn't necessary for all types of treatment: While some types of substance abuse treatment may not require pre-authorization from Tricare, others do. It's always best to check with your provider or Tricare representative before beginning any type of treatment to ensure that it will be covered.
4. All providers who accept Tricare offer substance abuse treatment: While many providers do accept Tricare and offer substance abuse treatment, not all do. It's important to verify that a provider offers the specific type of care you need before scheduling an appointment.

By understanding these common misconceptions about Tricare coverage for substance abuse treatment, you can make informed decisions about your care and avoid any unexpected out-of-pocket expenses. Remember, if you have any questions or concerns about your coverage or how to access care, don't hesitate to reach out to your provider or Tricare representative for assistance.

If you or a loved one is struggling with substance abuse, it's important to talk to your healthcare provider and your Tricare representative to understand your coverage options. Substance abuse treatment can be expensive, but Tricare can help make it more affordable. With the right treatment and support, recovery is possible.