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TRICARE Rehab: Insurance Coverage for Addiction Treatment Services

TRICARE Rehab

What is TRICARE Health Insurance?

TRICARE is a healthcare program serving eligible members, including active-duty service members, retirees, and their families worldwide. It provides comprehensive coverage to eligible beneficiaries from the military community, including the U.S. Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the U.S. Public Health Service, and the Commissioned Corps of the National Oceanic and Atmospheric Administration.

TRICARE offers several types of plans, including TRICARE Prime, TRICARE Select, TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE for Life. The specific benefits and eligibility requirements vary depending on the chosen plan and the individual’s status within the military community.

In 2017, TRICARE expanded its mental health benefits to include addiction treatment coverage. This expansion covered treatment for opioid addiction and other substance abuse issues, addressing an ongoing problem within the United States Military. These changes aim to assist active duty and retired service members struggling with addiction by providing access to various treatment options.

Addiction Treatment Services Covered by TRICARE Insurance

TRICARE coverage is offered for certain services and programs related to addiction and mental health treatment, such as:

  • Detoxification
  • Inpatient services
  • Residential substance treatment
  • Partial hospitalization program
  • Intensive outpatient program
  • Standard outpatient treatment
  • Intervention program
  • Medication-assisted treatment
  • Family therapeutic services

Coverage for specific treatments depends on factors such as the individual plan details, location, and the type of treatment.

TRICARE Plans

TRICARE offers several plan options to meet the diverse needs of its beneficiaries. All plans comply with or exceed the standards set by the Affordable Care Act, ensuring quality healthcare coverage. The available plans include:

  • TRICARE Prime: Coverage in designated ‘prime’ locations within the United States.
  • TRICARE Prime Remote: Coverage in remote U.S. locations and some overseas areas.
  • TRICARE Select: Fee-based coverage without enrollment requirements.
  • TRICARE Standard Overseas: Comprehensive coverage for individuals overseas.
  • TRICARE for Life: Medicare supplement for those with Medicare Parts A and B.
  • TRICARE Reserve Select: Premium-based plan for qualified reserve service members and families.
  • TRICARE Retired Reserve: Premium-based plan for retired service members under 60 and their families.
  • TRICARE Young Adult: Coverage for young adult children ineligible for other TRICARE plans.

Specific insurance coverage details depend on an individual’s service qualifications and eligibility criteria.

TRICARE Insurance: In-Network and Out-of-Network Providers

TRICARE typically provides full coverage for select in-network providers approved by the insurance company. In-network providers enter a pricing agreement with TRICARE to bill for addiction treatment services, ensuring standardized and transparent costs. Patients using in-network addiction treatment centers are responsible for a small portion of the cost as an out-of-pocket expense. Certain TRICARE coverage plans allow patients to use out-of-network providers, but they may have to file individual claims, pay a higher percentage of the service cost, and potentially cover the full cost initially before seeking reimbursement.

At Alpha Recovery Center, we offer comprehensive addiction treatment services covered by TRICARE. Our treatment center is an in-network provider with most TRICARE plans, making it easier for patients to access the help they need without financial barriers or having to pay higher costs for care. By accepting most insurance providers, including TRICARE and TRICARE West, we aim to support your journey to an addiction-free lifestyle by offering a range of covered services and support groups.

Alpha Recovery Center offers comprehensive treatment and support for individuals battling addiction and co-occurring mental health challenges.

Does TRICARE Cover Drug or Alcohol Rehab?

TRICARE health insurance typically covers treatment for substance abuse, including drug and alcohol rehab. If you are seeking addiction treatment services and have TRICARE West or TRICARE coverage, you are eligible for coverage at various treatment centers across the country. However, TRICARE rehab coverage may vary depending on the specific provider, the member’s health plan, and other factors.

Drug and Alcohol Detox

TRICARE plans provide coverage for various types of detox, including outpatient and inpatient detox. However, having inpatient coverage does not guarantee full coverage for detox. Some plans may require individuals to pay partial fees or obtain a doctor’s authorization and recommendation. Additionally, TRICARE may determine that outpatient detox is sufficient for certain individuals.

Residential Treatment

TRICARE covers residential treatment, also known as inpatient treatment, if certain conditions are met, such as having a formal substance use disorder diagnosis, experiencing withdrawal symptoms severe enough to require physician assistance, and struggling to function in everyday life. If these requirements are met, TRICARE will cover both emergency and non-emergency inpatient addiction treatment. Emergency treatment involves immediate medical attention for a medical or psychiatric crisis, covering costs like detox, stabilization, and medical complications. Non-emergency treatment is when an individual chooses to seek treatment for substance use disorders on his or her own. This requires prior authorization from TRICARE and typically includes detox, stabilization, and potentially treatment for co-occurring mental health conditions, depending on the plan.

Partial Hospitalization Programs

TRICARE covers partial hospitalization programs (PHPs), known as day treatment programs. These highly structured outpatient programs provide a level of care similar to inpatient rehab. Patients attend treatment sessions for most of the day, several days per week while residing at home or in a sober living facility. PHPs offer evidence-based therapies and support with a slightly lower intensity than inpatient care.

Intensive Outpatient Programs

Intensive outpatient treatment programs (IOPs) are covered by TRICARE and offer a more intensive level of outpatient care compared to standard outpatient care. Patients participate in structured therapy sessions multiple times per week, typically for several hours each day. IOPs provide evidence-based therapies and support similar to inpatient programs but allow the flexibility of living at home or in a sober living environment. These programs also typically require prior authorization from TRICARE to ensure coverage.

Standard Outpatient Rehab

TRICARE covers standard outpatient rehab programs, which involve regular therapy sessions and counseling. Patients attend scheduled appointments at a treatment facility while living at home or in a sober living residence. The frequency and duration of sessions vary based on individual needs.

tricare drug rehab

Does TRICARE Cover Suboxone?

TRICARE health insurance plans typically provide coverage for Suboxone, a medication used in the management of opioid addiction. Suboxone helps reduce symptoms of withdrawal and cravings, allowing patients to focus on other forms of addiction treatment, like behavioral therapies.

Coverage Requirements for Suboxone

To receive coverage for Suboxone under TRICARE, members must first obtain pre-authorization for their treatment. Without insurance, the generic form of Suboxone can cost up to $200 for a one-month supply. TRICARE plans cover various medication-assisted treatments, including Suboxone, as these treatments have proven effective in alleviating withdrawal symptoms and cravings associated with opioid addiction.

Medication-Assisted Treatment

In addition to Suboxone, TRICARE may cover other medication-assisted treatment options for opioid addiction. These treatments combine medications with behavioral therapies to provide a comprehensive approach to addiction recovery. By reducing withdrawal symptoms and cravings, medication-assisted treatments can increase the chances of successful long-term recovery.

It’s important to note that coverage details and out-of-pocket costs may vary depending on the specific TRICARE plan and the treatment provider. Consulting with a TRICARE representative can provide more accurate information about coverage and costs for medication-assisted treatments like Suboxone.

Does TRICARE Cover Therapy?

TRICARE health insurance typically provides insurance coverage for various forms of therapy and counseling services. This includes individual therapy sessions, group counseling, family therapy, and treatment for co-occurring mental health disorders. TRICARE also covers psychological testing and assessments to help in diagnosing mental health conditions, which is a crucial part of the treatment process.

Individual and Group Therapy

TRICARE members can receive coverage for one-on-one therapy sessions and counseling appointments. Group therapy sessions are also covered for a range of mental health issues. This allows individuals to participate in group discussions and receive support from others facing similar challenges.

Family Therapy

In addition to individual and group therapy, TRICARE often covers marriage and family counseling. This type of therapy can help address relationship issues and provide support for family members impacted by mental health or substance abuse concerns.

Psychological Testing

TRICARE covers various types of psychological testing and assessments. These evaluations can help diagnose mental health conditions and determine the most appropriate treatment approach for each individual.

tricare rehab for drug and alcohol addiction

TRICARE Rehab

At Alpha Recovery Center, we offer personalized treatment plans to assist individuals in overcoming substance misuse and mental health disorders. Our approach to treating drug and alcohol abuse combines evidence-based therapies and support services tailored to each person’s unique needs. We understand the challenges of addiction and are dedicated to providing a compassionate and supportive environment for recovery.

If you or a loved one is struggling with substance abuse, we encourage you to reach out to us. Call us at (866) 307-3949 or visit our contact page to learn more about our programs and services. With commitment and the right support, it is possible to overcome addiction and regain control of your life.

Alpha Recovery is Your Ally in Building Financial Resilience

We believe that financial barriers should not prevent anyone from accessing high-quality addiction treatment. At Alpha Recovery Center, we work with a broad range of insurance providers to ensure individuals struggling with addiction can access effective care and treatment tailored to their specific needs. Our dedicated team is here to guide you through the intricacies of your insurance benefits, helping you to fully understand and maximize your coverage for the treatment you need.

Eric Chaghouri, M.D.

MEDICALLY REVIEWED BY

Dr. Eric Chaghouri
Psychiatrist


Check if your insurance coverage will cover the cost of treatment.

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