If you or someone you love is looking for a rehab that accepts TRICARE insurance, contact us today at (800) 270-4315 to have our team run a confidential, no-cost verification of your benefits, or click here to complete our insurance form. Get help today using your benefits.
It’s a healthcare program for military members, veterans, and their families. The program balances civilian providers and the military healthcare system. This program helps active military, retirees, and their families access healthcare.
Members who are on active duty must enroll in Prime. All others who are eligible can choose to enroll in Prime or use Select. Prime offers fewer out-of-pocket expenses than Select but has less freedom of providers. Prime has four veteran recovery program forms:
The four plans only differ only in the geographical area each covers.
There are two separate groups, Group A where the service members entered active duty before 2018, and Group B where the service members entered active duty in 2018 or later.
Not everyone is eligible. Those who are eligible are active-duty service members and their families. Retired service members, their families, and National Guard/Reserve members and families are eligible for TRICARE. Beneficiaries of TRICARE and Medicare are survivors of service members. Children, former spouses, Medal of Honor recipients, and their families. Dependent parents, parents-in-law, and Foreign Force members and their families are eligible.
It covers medically necessary services, including maternity, mental, dental, and vision health services. Prescription drugs listed in the formulary are covered. For services, custodial care is covered for an institution or at home for those service members who are seriously ill or injured. Some aspects of care that may be covered for other beneficiaries include limited specific skilled nursing services for one hour per day, prescription medicines and up to 12 physician visits per year, and medically necessary services.
TRICARE health insurance covers mental health rehab and addiction recovery services. Some mental health diagnoses they cover are stress-related disorders (PTSD), anxiety disorders, co-occurring mental health conditions, substance abuse disorders, depression and mood disorders, obsessive-compulsive disorders, trauma disorders, and personality disorders. They also cover services for addiction recovery in Florida.
Retirees are eligible to continue with their Health Insurance if they enroll in a retiree program. When you retire from active duty or turn 60 as a retired reserve member, you and eligible dependents can still get medical coverage. You need to reenroll within 90 days of retirement because coverage is not automatic after retirement. Your choices are:
TRICARE For Life (TFL) TRICARE beneficiaries are those who are over the age of 65 and are eligible for Medicare. You need to be enrolled in Medicare Part A and B.
Retired National Guard/Reserves under age 60 are eligible to enroll in Retired Reserve (TRR). However, after age 60, you must choose a new plan, such as Prime or Select.
Yes, TRICARE covers drug and alcohol detox. In fact, the Affordable Care Act mandates that insurance providers must provide some coverage for mental health services. This includes coverage for substance use disorders.
Note that they cover treatment that is medically necessary. This means that domiciliary and aversion therapy is not within the scope of what is considered medically necessary. Yet, most other services do fall under the umbrella of necessary treatment. This means that your treatment is most likely taken care of.
TRICARE covers many treatment options. These allow patients to get treatment for drug and alcohol detox. According to their plan they offer the following:
Since this is far from a comprehensive list, it is crucial you look over your individual policy or contact our admission experts — especially if there are any questions. Here is a bit more information that may help.
Emergency hospitalization inpatient services cover things like detoxification and stabilization. They may also cover emergency medical complications arising from a substance use disorder.
For residential outpatient services, there are stipulations. Yet people with withdrawal symptoms — for example, those who have extreme distress or need inpatient treatment — may be considered. In some cases, those who need 24-hour monitoring are also considered.
General coverage on medical detox via partial hospitalization treatment falls under coverage. Or residential treatment is typically under the coverage umbrella.
Here are typical residential treatments and partial hospitalization programs covered:
For residential inpatients, they need a DSM-5 formal diagnosis of substance use disorder. This should also fall under covered treatment.
Within partial hospitalization, there are certain criteria to meet. For example, if the patient doesn’t need 24-hour hospitalization, that patient cannot maintain treatment through outpatient services to qualify. If there is medical detox required, the patient has coverage. And if access to medical services is available, this too counts along with the former.
According to their plan, they will pay for emergency and non-emergency inpatient services. This also includes partial hospitalization programs and residential substance use disorder treatment. As always, check your policy first. Or call and ask our admission experts questions, but these are typical services covered according to their site. Of course, the length of your stay and recovery will vary from others. This depends on things like the state you live in, or even your individual insurance policy. There are always other considerations. Another thing to keep in mind is the area of treatments and assessments.
According to their policy page, the following things are covered:
The easiest way to find if your policy covers drug rehab and drug and alcohol detox is simple: Talk to one of our admissions specialists. Have your insurance information available when you call. We work directly with TRICARE on your behalf. And we find all applicable benefits based on your individual policy.
We realize that dealing with insurance can be not just a hassle but overwhelming. That is why we take the pressure off of you and work with the insurance company directly. This usually takes less than an hour. Just call Transformations Treatment Center at (800) 270-4315 to get started. We’re just a phone call away and help you with the admissions process so you can focus on your recovery.
Exclusions: https://tricare.mil/CoveredServices/IsItCovered/Exclusions. Accessed 10 Aug. 2022.
Open Enrollment – Pharmacy Benefit Plans: https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/#/. Accessed 10 Aug. 2022.
MyMilitaryBenefits: https://www.mymilitarybenefits.com/benefits/tricare-basics/. Accessed 10 Aug. 2022.
Retirees: https://www.militarybenefit.org/membership-benefits/get-educated/tricareforretirees/. Accessed 10 Aug. 2022.
Retired Reserve®: https://www.tricare.mil/Plans/HealthPlans/TRR. Accessed 10 Aug. 2022.
MyMilitaryBenefits: https://www.mymilitarybenefits.com/benefits/what-tricare-covers/. Accessed 10 Aug. 2022.
