TRICARE Insurance Coverage For Addiction Treatment

TRICARE is a government-funded and run health insurance program for active duty service members (ADSMs) and retired service members and their families, and some other beneficiaries.

TRICARE began in 1993 as the insurance program to replace the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) program.

TRICARE’s coverage areas in the U.S. were recently consolidated into two regions: TRICARE West and TRICARE East.

Around the world, military personnel can find services under TRICARE Europe, TRICARE Pacific, and TRICARE Latin America and Canada.

Does TRICARE Cover Rehab?

Yes, TRICARE covers addiction treatment in a variety of settings and includes many different services.
For example, substance use disorder treatment through TRICARE includes inpatient and outpatient levels of care, therapy for dual diagnosis treatment, and opioid addiction treatment.

Substance Abuse Treatment Services Covered By TRICARE

If you are looking for substance abuse treatment coverage through TRICARE, take a moment to review the table below to see what TRICARE covers and what it doesn’t.

TRICARE Coverage By Treatment Type

As you can see from the table above, TRICARE offers insurance coverage for several treatment types and services.

Now take a closer look at the coverage TRICARE offers by browsing the tabs below.

TRICARE Plan Types

TRICARE offers several plan types for people who are active duty, Army Reserve/National Guard, or retired military personnel.

Some plans have Remote, Overseas, or Remote Overseas options for people who live in remote areas in the U.S., overseas, or in remote areas overseas.

TRICARE health plan types include:

• Prime
• Select
• For Life (which combines TRICARE with Medicare A and B coverage)
• Reserve Select (for members who are not on active duty orders and meet other qualifications)
• Retired Reserve (for members under the age of 60 and retired from Reserve duty)
• TRICARE Young Adult (which adult children or service members may be eligible for when their coverage ends at age 21)
• U.S. Family Health Plan (for a range of individuals including survivors, qualified former spouses, Medal of Honor recipients, and others)

How To Use TRICARE Coverage For Substance Abuse Treatment

If you have TRICARE insurance, you can use it for substance abuse treatment in the large network of military hospitals and clinics by simply presenting your insurance information.

If you rely on civilian clinics and hospitals, you can also use TRICARE there, provided it is a provider authorized by TRICARE.

TRICARE Co-Pays And Deductibles For Addiction Treatment

ADSMs and their families do not have to pay anything out-of-pocket, including deductibles, co-pays, coinsurance, or monthly premiums.

For others, there may be some costs associated with care.

These costs include:

• co-pays ranging from $24 to $36 for outpatient care
• $73 co-pay for emergency services
• $182 co-pay for inpatient treatment
• $4,262 cap on out-of-pocket expenses

Out-of-network costs are higher and may involve coinsurance. People in different times of life and on different plans may have slightly different co-pays.

What Addictions Does TRICARE Insurance Cover?

TRICARE covers many different forms of substance abuse including addiction to illicit drugs and prescription drugs.

Covered addictions include those involving the following:

• opioids
• alcohol
• prescription stimulants
• illicit stimulants such as methamphetamine and cocaine
• heroin
• prescription benzodiazepines

What If My Insurance Plan Doesn’t Cover The Treatment Program I Need?

If your insurance plan doesn’t cover addiction treatment, you have some other options that you can look into.

There are other government-funded health insurance programs such as Medicaid, Medicare, or state-funded health insurance that you may qualify for depending on age and income.

You may also want to investigate treatment centers that receive government grants such as block grants or awarded grants from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Finally, when you are investigating treatment centers, ask them if they offer scholarships, payment plans, or a sliding fee scale for people who can’t afford substance abuse treatment.

Finding A Rehab Center That Accepts TRICARE

If you are looking for an addiction treatment center that accepts TRICARE, start with military hospitals or clinics in the TRICARE network.

If you aren’t sure where to go, ask your primary care manager (PCM), who is assigned to you at the beginning of coverage, to help you find a location.

If a military clinic isn’t available, you can use TRICARE insurance at a TRICARE-authorized civilian provider. Once again, your PCM should be able to help you find a facility.

Find Substance Abuse Treatment Today

If you or a loved one are looking for substance abuse treatment, call us today. We have more information for you about your treatment options and how to access them.

Written by the Addiction Resource Editorial Staff