Does TRICARE Cover Drug Rehab?

The short answer is yes, service members and their families receive varying degrees of coverage for addiction treatment services and therapies. The exact amount of coverage depends on your specific insurance plan, whether you receive care from an in-network or out-of-network provider, and your range of pre-authorizations.

Comprehensive coverage, from detox and inpatient care to outpatient programs and ongoing counseling, is generally available. You may still have some out-of-pocket expenses, particularly if you receive care from providers outside the network.

Addiction Treatment Covered by TRICARE Insurance

TRICARE typically covers services that are proven safe and effective, and it doesn’t cover anything considered experimental. Services must also be deemed medically necessary for your specific condition for them to be covered. Further, several medical exclusions, limitations, and special rules may apply, although addiction treatment is generally unaffected by these.

You’re typically covered to receive addiction treatment services and therapies such as those detailed below, as well as others.

Detoxification

TRICARE covers detoxification costs as well as services aimed at minimizing withdrawal symptoms. These services are covered when provided at a skilled level by an authorized provider of inpatient services, by partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs), and by opioid treatment and residential substance use disorder treatment facilities.

For those with an opioid use disorder, TRICARE covers medication-assisted treatment (MAT) from authorized providers. The facility must be certified in the use and prescription of buprenorphine (Suboxone) by the U.S. Drug Enforcement Agency. If you need direct access to medical services and monitoring during detox, pre-authorization isn’t required for MAT.

Inpatient Rehab

TRICARE insurance provides coverage for residential substance use disorder rehab in authorized inpatient facilities, although pre-authorization is required. Approval is typically given if you’ve been diagnosed with a substance use disorder and/or you have potential symptoms requiring full-time inpatient care and physician management.

Additionally, inpatient psychiatric hospitalization is covered for those with substance use disorders as well as for the diagnosis and/or treatment of mental health conditions. Pre-authorization is required in both situations as these are considered nonemergency services.

Outpatient Services

For those who need treatment for mental health conditions and substance use disorders but don’t require full-time hospitalization, outpatient services offer flexible options. These programs provide support in the community, including medically monitored detox, direct access to medical services, relapse prevention, symptom reduction, and stabilization.

Outpatient care also aims to help individuals suffering from impairments that prevent them from normal everyday functionality. As such, these programs are designed for people who need nonresidential care and those transitioning from inpatient programs, and lower levels of outpatient care.

Your health insurance coverage opens up pathways to the following types of outpatient services:

• TRICARE covers intensive outpatient programs (IOPs) from authorized providers. Pre-authorization may be required for some IOPs; your regional contractor can help you determine whether that’s the case.
• TRICARE covers partial hospitalization programs (PHPs) from authorized providers. PHPs are only available in the United States and its territories, and pre-authorization isn’t required.

Specialized Therapies

TRICARE covers mental health therapeutic services and specialized therapies in various circumstances. Many of these services can help a great deal to manage PTSD, drug and alcohol abuse disorders, family issues, and more.

Continue reading or scroll down to the therapies section for a detailed overview of what’s covered by your health insurance plan.

Therapies Covered by TRICARE Insurance

The following non-exhaustive list details the major types of mental health services covered by TRICARE:

• Coverage is provided for individual, group and family counseling sessions or psychotherapy.
• Psychoanalysis is covered for individuals who are pre-authorized and receiving care from a certified provider.
• Testing and assessment are covered for the purposes of diagnosis and treatment plans.
• Ancillary therapies such as art, music, dance, occupational, and others are covered when part of a treatment plan. These therapies must be provided at a residential substance use disorder or other inpatient facility or as part of an IOP or PHP.
• Medication-assisted treatment is covered for individuals diagnosed with drug and alcohol abuse disorders.
• Other covered services include psychotropic drugs, electroconvulsive treatment (ECT), and collateral visits for family members.

How to Maximize Your TRICARE Drug Rehab Coverage for Addiction

How long will TRICARE cover addiction treatment?

This depends on factors such as your health insurance plan, your authorized treatment plan, the type of rehab required, and the facility itself. Generally, you’ll be covered for at least the typical duration of the rehab program as long as it remains medically necessary and appropriate for you.

How do I check that TRICARE covers treatment?

The TRICARE website provides detailed information on substance use disorder treatments. Alternatively, you can talk to our team to ask about specific concerns. Simply submit your details to our team of specialists at Camelback Recovery to check your insurance coverage.

What can I do if TRICARE does not cover treatment?

Our specialists will do everything possible to gain pre-authorization for treatment on your behalf. If this is still not possible, however, we may be able to arrange a payment plan on a sliding scale based on your income. Unfortunately, you may be responsible for the full cost of treatment if these steps are unsuccessful.