Does TRICARE Cover Rehab for Substance Use Disorders?
A soldier’s story doesn’t end when a war is won or a term is served—for many, what happens after can be just as harrowing. Anxiety medications, prescribed in good faith to treat post-traumatic stress disorder (PTSD) symptoms, can become addictive if not taken with great care. Dependency on painkillers following intensive medical treatment for combat-related injuries is all too common. Alcohol and recreational drugs, meanwhile, may seem like the only accessible coping mechanism for veterans who may feel trapped or adrift in their life following service.
Addiction specialists can help you, or your loved one, learn skills and strategies that will help you cope more healthily with what you are struggling with so that you can move forward with your life. However, you may be wondering how you will cover the costs of a military addiction treatment program. Insurance can be a lifesaver at a time like this, but does TRICARE cover rehab for substance use disorders?
Does TRICARE Cover Rehab Costs?
The short answer is yes, TRICARE will cover rehab costs in many cases. Note, however, that coverage will depend on eligibility as well as where you seek treatment, how urgent your need is, and what specific treatments are prescribed.
|
Treatment Type |
What’s covered? |
When is it covered? |
| Emergency Inpatient Hospital Services |
|
In the event of a medical or psychiatric crisis necessitating immediate medical attention. |
| Intensive Outpatient Programs (IOPs) |
|
When your symptoms are significant enough to necessitate a higher level of care than regular outpatient programs but not full-time hospitalization. |
| Partial Hospitalization Programs (PHPs) |
|
When your symptoms interfere significantly with your daily life, necessitating a higher level of care than an IOP offers but not 24/7 residential treatment. |
| Residential Treatment Center (RTC) Programs |
|
When your symptoms are severe enough that you require 24/7 support, but not emergency hospitalization. RTC coverage requires prior approval and is more likely to be approved if you are under 21, are significantly impaired by your symptoms, and/or are struggling with a co-occurring disorder. |
| Medication-Assisted Treatment (MAT) |
|
When you need opioid detox and follow-up medical support, but not 24-hour care. Requires special certification from the Drug Enforcement Agency (DEA) for a buprenorphine prescription. |
| Mental Health Services |
|
When you need psychological support as part of your recovery process. All therapies must be prescribed by a qualified provider at an eligible addiction treatment facility or psychiatric care center. |
Simply put, TRICARE only covers proven, evidence-based approaches to addiction treatment that are deemed medically necessary for recovery. The long list of services that are not covered by TRICARE includes alternative treatments, such as acupuncture and massage, as well as treatments for unrelated issues like dyslexia. Most notably, TRICARE does not cover assisted living facility care, or home alterations (i.e. adding ramps for wheelchair accessibility).
| Are You or Your Loved One Eligible for TRICARE Coverage?
TRICARE beneficiaries include sponsors (active duty, retired, and Uniformed Service or National Guard/Reserve members) and family members, defined as spouses and children who are registered in the Defense Enrollment Eligibility Reporting System (DEERS). The specific benefits and plans you or your loved one may be eligible for is determined by which particular beneficiary category you fall under—see the full list for more details. |
Using TRICARE to Pay for Addiction Rehab
If you need to enroll in TRICARE for the first time or make changes to an existing plan, you may do so for premium-based plans—such as the Reserve Select, Retired Reserve, Young Adult, and Continued Health Care Benefit Program plans—at any time. Alternatively, you can enroll or make changes to a Prime or Select plan at one of two times:
- During Open Season—which begins on the Monday of the second full week in November and ends on the Monday of the second full week in December. During this time, enrollment is open to anyone who may qualify; changes may be made to existing plans as well.
- After a Qualifying Life Event (QLE)—a major life change that may affect your eligibility. These include things like retiring from active duty, new additions to your family, suffering a family loss, moving, and gaining or losing other health insurance plans. To utilize this option, you must first register the QLE with DEERS and then enroll or make any desired changes to your plan within 90 days of the event. Fees and premiums may apply.
In some cases, TRICARE will automatically cover your rehab costs. Emergency hospitalization, medically assisted treatments, and partial hospitalizations all fall under this umbrella. However, you must secure authorization from TRICARE to get coverage for a residential treatment program, and intensive outpatient programs may require this step as well. When in doubt, don’t assume—always contact your regional TRICARE contractor to check your plan’s specific requirements.
Finding an Addiction Treatment Center That Accepts TRICARE
Now that you know whether TRICARE will cover your rehab needs, a new question arises: Will your rehab center of choice accept your insurance?
TRICARE will typically ask you to go to the nearest qualifying treatment center. However, it can sometimes be difficult to ascertain at a glance whether a given facility will accept your coverage. At this point, it’s time to make a call.
A rehab facility’s admissions staff can help verify your insurance and clarify your treatment options if you’re still unsure what is and isn’t covered under your plan. And, if you find that you may need different coverage than TRICARE can offer, or that the facility you’ve contacted isn’t right for you after all, your point of contact should be able to make recommendations that will point you in the right direction.
Whether or not TRICARE is right for you or your loved one, help—and hope—are never out of reach. There are other financial options out there if you need them, and for every treatment center that does not accept TRICARE coverage, there is another that does. Pick up the phone today to begin finding the answers you seek—and the help you need to forge a path to recovery.
