Tricare insurance provides benefits to individuals seeking addiction and mental health treatment. It is normal to have concerns about insurance coverage while seeking treatment. Insurance can seem like a difficult challenge to tackle. We assure you however that Tricare insurance will help you get the support you need. 

Our recovery specialists will give you an overview of your benefits after speaking with your provider. With the right coverage and support, you’ll begin to see your life shift for the better. 

Navigating Tricare Insurance Terms

Understanding some vocabulary in insurance is beneficial as you start the treatment process. Though we will take care of the insurance evaluation for you, understanding these terms may still be useful. These terms include:

Premium

An insurance plan premium is a payment you make to your provider that keeps your plan active. 

Out-of-Pocket Maximum

This is the most that you’ll have to pay for covered services within a plan year. After these costs are taken care of through deductibles, copayments, and coinsurance, your insurance provider will cover the remaining costs.

Policy Effective Date

This is when your policy begins. In other words, this is when it will be deemed as effective. You’ll get access to your benefits, which vary depending on your plan. 

Deductible

A deductible is an amount that must be paid for covered medical services before your provider begins paying.

Copayment

A copayment, or copay, is a cost you may pay before you receive a medical service. For instance, let’s say you need to pay $2,000 for inpatient treatment at a treatment center. Your health insurance plan may pay half of that price, and then require a $500 copayment to cover the rest. 

Does Tricare Insurance Cover Mental Health Care Costs?

Tricare insurance provides care for psychological disorders. Keeping in mind the principal cause of addiction is important in treating addiction. This is much more than just a physical disease. Addiction affects the emotional and mental state of an individual, too. 

Luckily, you’ll be able to enjoy the benefits of mental health services at our treatment center with Tricare insurance. We offer several types of therapy, such as cognitive behavioral therapy and group therapy.

How Do We Determine Your Benefits?

We’ll be able to let you know exactly what the coverage provides when we go through your Tricare Insurance plan. Our primary objective is to provide you with affordable and high-quality treatment.  

Our addiction experts will contact your provider and ensure that the most benefits are taken from your plan. We go through a simple two-step process. 

These simple steps include:

Step 1: Validating Your Tricare Insurance Benefits 

We will start by evaluating your insurance benefits thoroughly. We will then reach out to the provider to decide what sort of benefits are offered by the individual program. 

Step 2: Verifying Addiction and Mental Health Benefits of Your Tricare Insurance Plan

After the in-depth evaluation, we’ll let you know:

  • How much of the expenses your insurance company will cover
  • What level of care you’ll be covered for
  • The length of time you’ll be covered for inpatient care (30, 60, 90 days, etc.)
  • How much you can expect to pay out-of-pocket for a treatment program

Tricare Prime Plan

Tricare Prime is a managed care option available in “Prime Service Areas,” such as the East Coast. Tricare Prime ensures medical readiness of active duty by adding to the capability and capacity of military hospitals and clinics. Prime Service Areas were also built around the Base Realignment and Closure sites.

Additional Prime options for active duty service members and their families include:

  • Tricare Prime Remote
  • Tricare Prime Overseas
  • Tricare Prime Remote Overseas 

Who Can Enroll in Tricare Insurance Prime?

  • Active duty service members and their families
  • Retired service members and their families*
  • Activated
  • Called or ordered to active duty service for more than 30 days in a row
  • Guard/Reserve members and their families
  • Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
  • Retired Guard/Reserve members at age 60 and their families*
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

*When retired service members and their families become eligible for Medicare based on age, they aren’t able to participate in Tricare Prime.

How Does Tricare Insurance Work?

You have an assigned primary care manager (PCM) who will help guide you through coverage. Your primary care manager will help:

  • Refer you to specialists for the care he or she can’t provide
  • Work with your regional contractor for referrals/authorization
  • Accept your copayment
  • Files claims for you

What You Pay

Active duty service members pay nothing out-of-pocket. Active duty family members also pay nothing out-of-pocket unless using the point-of-service option. 

All other members pay annual enrollment fees and network copayments.

Tricare Select Plan

Tricare Select is a fee-for-service plan available in the U.S. You must show eligibility for Tricare in the Defense Enrollment Eligibility Reporting System (DEERS). You need to register in DEERS in order to get Tricare insurance under the Select Plan.

Who Can Participate?

  • Active duty family members
  • Retired service members and their families
  • Family members of activated
  • Called or ordered to active duty service for more than 30 days in a row.
  • Guard/Reserve members 
  • Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
  • Retired Guard/Reserve members at age 60 and their families
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

How it Works

The first step is an appointment with any authorized Tricare provider. An approved provider is any individual, institution/association, or supplier licensed by a state, accredited by a national organization, or meeting certain medical community requirements, and certified under Tricare insurance to provide benefits. 

There are two types of Authorized Tricare providers: Network and Non-Network. Referrals are not essential, but for some programs, you may need prior authorization from your regional contractor.

What You Pay

Costs will be dependent upon the sponsor’s military status. You will have to take care of:

  • An annual outpatient deductible
  • Cost shares (or percentage) for covered services

Is Tricare Select Right for You?

If you’re on active duty (including activated Guard/Reserve members), you are not eligible for Tricare Select. 

Tricare Select may be a great fit for you if:

  • You live in an area where you can’t use Tricare Prime
  • You have other insurance providers
  • Health insurance you have in addition to Tricare, such as Medicare or employer-sponsored health insurance. 
  • You’re seeing a provider who isn’t in the Tricare network and you don’t want to switch.

Covered Treatments under Tricare Insurance

Tricare insurance covers medically and psychologically necessary mental health and addiction care. This includes both inpatient and outpatient rehabilitation treatment. 

Tricare insurance can also help you cover treatments such as:

  • Applied Behavior Analysis
  • Autism Spectrum Disorder
  • Cognitive Rehabilitation Therapy
  • Collateral Visits
  • Drug Testing
  • Eating Disorder Treatment
  • Electroconvulsive Therapy
  • Family Therapy
  • Gender Dysphoria
  • Intensive Outpatient Programs
  • Inpatient Hospital Services (emergency and non-emergency)
  • Management of Withdrawal Symptoms (Detoxification) 
  • Medication-Assisted Treatment
  • Office-Based Opioid Treatment
  • Opioid Treatment Programs
  • Partial Hospitalization
  • Psychoanalysis
  • Psychological Testing
  • Psychotherapy
  • Psychotropic Drugs
  • Residential Treatment Treatment Center Care
  • Substance Use Disorder Treatment
  • Therapeutic Services
  • Transcranial Magnetic Stimulation

Tricare Insurance Coverage for Residential Treatment

Tricare covers residential treatment if:

  • The recovering individual has a formal substance use disorder diagnosis
  • The recovering individual undergoes withdrawal symptoms severe enough to require medical care
  • He or she struggles to function daily

If these requirements are met, Tricare will cover both emergency and non-emergency residential treatment. Tricare insurance takes care of detoxification, stabilization, and any medical complication costs when it comes to emergency treatment.

Tricare Insurance Coverage for Outpatient Treatment

If an individual’s plan meets certain qualifications, Tricare will also cover outpatient treatment. The best candidate is an individual who is currently struggling with addiction, but who does not need hospitalization or 24-hour care. 

Tricare insurance coverage takes into account the full spectrum of outpatient programs.  The least intensive form of care is standard out-patient treatment. Some services, such as intensive care, consist of multiple days of planned treatment sessions each week. 

A partial hospitalization program includes highly intensive care through approximately four to eight hours of daily treatment.

Does Tricare Insurance Cover Sober Living Homes?

Tricare insurance may include partial hospitalization services as one of their many benefits.  These services help people recovering from addiction gain rehabilitation by continuing to seek treatment and professional care. These facilities do not provide 24-hour care but provide a sober living environment.

Recovering individuals may need extra time to develop their skills. Sober living homes provide a safe and stable environment as individuals move along their recovery journey.    

Seek Help with Discovery Institute Today!

At Discovery Institute, we believe in high quality and affordable treatment. We encourage you to take that first step in long-term recovery by giving us a call.

If you have any questions, comments, or concerns, please don’t hesitate to reach out to us. We’re ready to take your call!

Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman, MDDr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.