TRICARE insurance may cover many different substance abuse rehab services such as detox, inpatient rehab, and sober living. But first, what is TRICARE?
TRICARE is a healthcare insurance program for active-duty service members, veterans, and their families, both in the U.S. and around the world. Nearly 9.5 million people use TRICARE for their routine healthcare needs.
If you’re an active-duty service member, a veteran, or a family member, chances are you can use TRICARE insurance to help cover the cost of addiction treatment services. Read on to learn about:
- The addiction treatment services TRICARE insurance may cover.
- If TRICARE covers services like drug and alcohol detox, inpatient rehab, and intensive outpatient rehab.
- How to use it to pay for treatment.
- Options to pay for treatment if TRICARE doesn’t cover the service.
What Does TRICARE Cover for Addiction Rehab?
A massive shift in its coverage options in 2017 led TRICARE to cover an expanded list of addiction treatment services. Coverage for these services may depend on what type of treatment you’re looking into, as well as where you want to be treated, specific plan details, and other factors.
There are several different ways to contact TRICARE if you have questions about coverage, including via phone and logging into their secure services.
TRICARE insurance may cover:
- Detox, which clears the body of the abused substances. This is often the first step for recovery and is ideally followed by other forms of treatment, as seen below.
- Medication-assisted treatment (MAT), or medication for minimizing cravings and symptoms. This may not be appropriate for all who seek treatment.
- Inpatient programs. This is essentially intensive, around-the-clock care where the daily schedule is carefully controlled so you can focus solely on recovery. This is different from residential treatment in that it may mean greater medical supervision.
- Residential, or live-in, treatment. Often the next step after detox, residential treatment provides 24-hour supervision and structured programs of classes, therapy, and treatment during the day.
- Partial hospitalization programs (PHP), sometimes known as day treatment. Although you don’t live at the facility, you would be required to attend intensive therapy and treatment most days of the week for a significant portion of the day.
- Intensive outpatient programs (IOP). A transitional step between residential treatment and living in recovery away from a facility, IOP requires several hours of treatment a week.
- Services for family members. Addiction doesn’t just affect the person using, but those around them. Your family might need resources of their own to understand addiction and figure out the best ways to help you through recovery.
TRICARE Health Plans
Like most insurance options out there, TRICARE provides a range of plans for active duty and military veterans. Below is a quick roundup of available plans, but you can find more information on the health plans on TRICARE’s website.
Contact your doctor or primary care manager to learn what addiction treatments and services are covered, as well as what locations provide these services.
Active-duty service members and their families—as well as retired and reserve members—are eligible for TRICARE Prime as long as they are not eligible for Medicare based on their age. You’ll have a primary care manager who will be your main point of contact.
Active duty members are required to enroll and will pay nothing out-of-pocket for the service. Other Prime options include:
- TRICARE Prime Remote.
- TRICARE Prime Overseas.
- Prime Remote Overseas.
What used to be TRICARE Standard and TRICARE Extra became TRICARE Select in 2018. You will manage this plan on your own (making it a preferred provider network plan), meaning there is no primary care manager.
There is also a TRICARE Select Overseas option.
TRICARE for Life
You don’t have to enroll in TRICARE for Life: TRICARE-eligible beneficiaries with Medicare Part A and B are automatically covered. A head’s up, though—you’ll have to pay Medicare Part B premium, which is based on your income.
TRICARE Reserve Select
TRICARE Reserve Select is available worldwide for Selected Reserve members as well as their families.
If you are a member of the Selected Reserve, you may be eligible for this premium-based plan. To be eligible, you must NOT be:
- On active-duty orders.
- Covered under the Transitional Assistance Management Program.
- Eligible for the Federal Employees Health Benefits program.
TRICARE Retired Reserve
Like TRICARE Reserve Select, Retired Reserve is a premium-based plan that is available to Select Reserve members worldwide. You have to be:
- Under 60 years old.
- Not enrolled in the Federal Employees Health Benefits program.
- A retired Reserve member of a Reserve Component qualified for non-regular retirement.
This plan is also open to family members and survivors of Reserve members, as well.
TRICARE Young Adult
This plan is specifically for adult children—TRICARE Young Adult can kick in at 21 (or 23 if the child is attending college) after their previous TRICARE plan ends. The young adult needs to:
- Have an eligible sponsor.
- Not be married.
- Be between 21 and 26 years old.
- Not be eligible for an employee-sponsored health plan if they work.
- Not be eligible for a different type of TRICARE plan.
Do Treatment Centers Need to Be In-Network?
The best chance for TRICARE to cover treatment services for substance abuse is if your treatment is deemed medically necessary by an in-network medical professional. At that point, you’ll need to choose a facility or service provider that is approved by TRICARE.
If you follow these steps, the facility will bill TRICARE for your addiction treatment services, and then, depending on your plan, you’ll be responsible for a portion of the cost. This would qualify as an out-of-pocket expense.
Certain TRICARE plans—such as TRICARE Select, Reservice Select, Retired Reserve, and Young Adult Select—may allow an out-of-network facility, but you may have to file your own insurance claims and potentially pay a higher rate for the services rendered.
How Can I Pay the Costs Not Covered by TRICARE Insurance?
Health insurance like TRICARE can help immensely when paying for addiction treatment, but it’s not the only way you can afford or pay for treatment. Some facilities offer payment plans and/or accept major credit and debit cards. Still others may offer scholarships for those determined to get into recovery.
Each facility is different, so make sure to look into what addiction treatment services they offer, what types of insurances they accept, and what other methods of payment they are willing to work with.