Insurance Provider Information

About TRICARE’s Substance Abuse Coverage

As substance use disorder is considered a mental health issue, the Affordable Care Act dictates that American health insurance companies must provide some degree of coverage to treat it. TRICARE offers a comprehensive approach to addiction treatment services, emphasizing a wide range of approaches that include elements like medication assisted therapy. Plans within the program vary, so you should expect to incur some out-of-pocket expenses for rehab.

TRICARE offers coverage for emergency and non-emergent inpatient hospital services for detoxification and stabilization and any medical issues that may arise from substance abuse.

Understanding Your TRICARE Insurance Coverage

When determining the extent to which your TRICAREpolicy coversdrug rehab, it helps to understand some of the standard terms used to describe your policy parameters.

  • Co-pay/coinsurance: Your co-pay or coinsurance is the amount you’ll pay out-of-pocket for services, depending on the percentage designated by TRICARE per your specific policy. For instance, if your policy stipulates a co-pay of $250 for inpatient services, you’re responsible for paying this amount to the provider. If you have a coinsurance rate of 25%, you’re responsible for 25% of the rehab facility’s overall bill and your policy pays the rest.
  • Deductible: The deductible is the out-of-pocket cost you have to pay annually before your policy kicks in to cover the rest of your health-care costs.
  • Premium: The insurance premium is the amount you pay monthly or annually to your provider for coverage.

 

TRICARE Insurance Substance Abuse Treatment Coverage Specifics

Drug rehab services covered by TRICARE depend on the type of treatment services you need and what professional treatment advice has led you to choose one option over another. The particulars of coverage may also vary depending on the regional contractor administering your policy, so check the details before settling on certain services. You may need to be flexible regarding residential treatment facility care, as your plan may only cover certain providers or services.

Residential Treatment Centers

TRICARE allows you to seek approval for substance abuse treatment coverage in a residential treatment facility if you fit the minimum requirements. These include:

  • Must have significant levels of impairment that interfere with the ability to function normally
  • Must be unable to function in your existing community using outpatient services
  • Don’t need full-time traditional hospital care
  • You’re transitioning from another program as part of a larger treatment plan

Preauthorization for inpatient residential treatment in a qualified drug rehab facility is necessary. Coverage may also be extended to those seeking part-time hospitalization services in conjunction with a residential treatment facility as an alternative to full-time inpatient care.

Medication Assisted Treatment (MAT) Services

 

If you’re struggling with addiction, MAT may be one of the more effective approaches to help you overcome it. This approach uses medications to tamp down cravings as you navigate drug rehab and learn to live free of addiction. It combines them with mental health therapies to help you cope with the behavioral aspects of substance use disorder.

TRICARE may cover this approach if the provider has a special certification from the Drug Enforcement Agency to prescribe the medications that form the foundation of MAT. Those with opioid use disorder may qualify for MAT based on this specific designation. Individuals requiring medical monitoring during detoxification may also be eligible for MAT under TRICARE health insurance.

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TRICARE is a health care insurance program for members of the U.S. armed services. Those eligible for a plan through TRICARE include uniformed service members and their family members, National Guard and Reserve members, former military spouses, survivors, Medal of Honor recipients and others registered through the Defense Enrollment Eligibility Reporting System. The program is managed by the Defense Health Agency, which operates under the auspices of the Department of Defense.

Among its offerings, TRICARE covers services for substance use disorder treatment for various rehab options around the country. Behavioral Health Centers is a TRICARE-covered rehab facility. If you have TRICARE coverage, your plan may cover some aspects of our substance use disorder treatment and military mental health treatment programs.

We Accept Most Insurance

Behavioral Health Centers does not accept Medicare or Medicaid.

We Accept Most Insurance

Behavioral Health Centers does not accept Medicare or Medicaid.

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Intensive Outpatient Drug Rehab

TRICARE also offers coverage for intensive outpatient drug rehab programs. To qualify, you must:

  • Have an official diagnosis of substance use disorder
  • Not need full-time care in a traditional hospital
  • Require stabilization, reduction of symptoms or relapse prevention services
  • Require treatment for mental health disorders that have only been partially stabilized
  • Need a higher level of care than traditional outpatient treatment
  • Be transitioning from an inpatient drug rehab

The need for preauthorization for intensive outpatient programs depends on your regional TRICARE benefits contractor.

 

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Group 691

Contact Us Today to Learn What Services Are Covered by TRICARE

The addiction treatment specialists at Behavioral Health Centers are prepared to help you with the specifics of your TRICARE health insurance coverage for drug and alcohol detox, mental health therapeutic services and inpatient/outpatient rehab. We also providefinancing through a third party to help with out-of-pocket costs.

Don’t allow concerns about cost and health insurance coverage derail your desire to get addiction treatment. This critical decision can impact the rest of your life, so take every possible avenue available to you to get the help you need. Reach out to Behavioral Health Centers today to learn more about how we can help you break free from the chains of addiction.