Tricare Insurance Coverage For Alcohol And Drug Rehab

Veterans may face several challenges when transitioning from military life to civilian life. Many veterans turn to substance abuse to cope with the stressors and trauma experienced during active duty.

The federal health insurance program Tricare covers effective treatments and levels of care for eligible veterans with substance use disorders (SUDs).

Tricare beneficiaries have access to an array of drug and alcohol use disorder treatments including inpatient care, partial hospitalization programs (PHP), opioid treatment, psychotherapy, and more.

Eligibility Requirements For Tricare Health Insurance

To be eligible for Tricare, you must be a uniformed service member, a retired veteran, a survivor, a former spouse, or a Medal of Honor recipient. The sole beneficiary of Tricare benefits is called a “sponsor”.

While sponsors may utilize Tricare health care coverage to its fullest extent, some family members may also be eligible to receive benefits, depending on your beneficiary category.

Types of beneficiaries include:

• children
• retired military members
• dependent parents and parents-in-law
• Foreign Force members and families
• National Guard/Reserve members and families
• beneficiaries eligible for Tricare and Medicare

If you or a loved one falls into one of these categories, you may be eligible to receive free or low-cost drug and alcohol rehab services through Tricare.

Active duty service members and retirees are automatically enrolled in Tricare insurance. Other potential beneficiaries will have to apply for insurance coverage through the Tricare website.

What Health Plans Are Offered By Tricare?

Health plans through Tricare will differ based on your beneficiary status. Active duty personnel, eligible veterans, and their dependents will usually qualify for free drug rehab services.

Different types of Tricare coverage include:

• Tricare Young Adult
• Tricare Retired Reserve
• Tricare Reserve Select
• Tricare Prime Remote
• Tricare For Life
• Tricare Prime
• Tricare Prime Overseas

Tricare Prime coverage ensures that there will be nearly no cost for health coverage. Other Tricare plans may require people to pay a portion of the cost for a health service or prescriptions with a cost-share or copayment option.

Substance Abuse Treatment Options Covered By Tricare

Veterans and other beneficiaries may be able to get an array of evidence-based alcohol and drug abuse treatments through Tricare.

Behavioral health treatment programs may include:

• medication-assisted treatment (MAT)
• withdrawal symptom stabilization
• medically monitored detoxification
• residential treatment
• dual diagnosis treatment for co-occurring mental health disorders
• intensive outpatient programs (IOP)
• inpatient treatment
• outpatient treatment
• 12-step programs for alcohol abuse
• group therapy
• mental health services

Addiction treatment services through Tricare will typically not cover holistic therapeutic services or unproven types of treatments unless they are part of a comprehensive evidence-based plan.

Do Rehab Centers Need To Be In-Network To Be Covered By Tricare?

Tricare insurance brings together military-run hospitals and clinics as well as a network of civilian health care institutions and pharmacies to serve Tricare beneficiaries.

Veterans with Tricare may use it to receive free treatment services at VA health care facilities or at military hospitals and clinics.

While people do have to use in-network or Tricare-authorized rehab centers to utilize coverage, there are thousands of facilities throughout the U.S. and abroad that accept Tricare.

Often, veterans will utilize their local VA rehab treatment program due to the affordability and quality of care provided.

Cost Of Substance Use Disorder Treatment With Tricare

Some veterans and other beneficiaries are eligible for free drug and alcohol rehab treatment, while others may have to pay a small price for treatment services.

The “catastrophic cap” refers to the most you or your family may pay out of pocket for health care services. No one with Tricare coverage will pay more than $4,000 in a given calendar year.

Tricare Coverage For Inpatient Rehab Programs

Inpatient admission to a rehab facility may cost anywhere between $25 to $200 depending on the type of Tricare coverage a beneficiary has.

Tricare Coverage For Outpatient Rehab Programs

Outpatient rehab programs will cost approximately $30 to $50 out-of-pocket with Tricare coverage. Out-of-network outpatient treatment centers will usually cost 20 to 30 percent higher.

Medication-Assisted Treatment Coverage Through Tricare

Medication-assisted treatment may be administered in an outpatient or inpatient rehab setting.

This essential service is almost always free of cost for veterans using Tricare, however, some out-of-network facilities may assess a small fee.

Mental Health And Dual Diagnosis Treatment Coverage

Dual diagnosis treatments for co-occurring mental health disorders is a prominent feature in most evidence-based rehab programs and is covered through most Tricare-authorized rehab facilities.

The cost of co-occurring treatment will depend on the type of Tricare coverage, but prices may range anywhere from $0 to $196 per admission.

Paying For Rehab Costs Not Covered By Tricare

Veterans and others who do not qualify for Tricare or VA health insurance have a range of other options to cover the cost of drug and alcohol rehab.

Other ways to pay for addiction treatment include:

• Medicaid insurance
• Medicare insurance
• government-issued grants for substance abuse treatment
• private health insurance plans
• veterans scholarships

Low-income people may also find free and low-cost treatment through donation-based nonprofit organizations. These types of facilities may request a small fee on admission to help cover boarding costs.

Find An Addiction Treatment Facility That Accepts Tricare Insurance

Call our helpline today for more information on alcohol and drug treatment services covered through Tricare. Our team can help you find an addiction recovery center that fits your needs.

Written by the Addiction Resource Editorial Staff