If you’re struggling with an alcohol use disorder, you can be confident that your TRICARE insurance will cover treatment that will help get your life back on track. TRICARE covers several different types and levels of treatment for TRICARE enrollees.
However, like any insurance, your TRICARE coverage may vary specific to your plan type and location.
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Understanding Your TRICARE Alcohol Treatment Coverage
TRICARE will likely help cover expenses if a medical provider says treatment is a medical necessity — basically if your addiction affects your ability to function in everyday life, or if your withdrawal symptoms are so severe that you require medical assistance.
Like all insurance providers, TRICARE must meet standards established by the Affordable Care Act (Obamacare). Keep in mind that some plans, and some forms of treatment, require prior authorization.
The TRICARE Network
In-network alcohol substance abuse treatment providers have negotiated with TRICARE to establish an agreement for fair and reasonable pricing. However, you may be required to pay a small out-of-pocket deductible or co-pay.
Some TRICARE plans, including TRICARE Select, Young Adult Select, Reserve Select, Prime Remote, and Family Health, offer members an option to select an out-of-network provider. If you’re covered by one of these plans and opt for out-of-network treatment, you may need to file individual claims, and you will probably pay higher out-of-pocket expenses.
TRICARE Covers Various Levels of Alcohol Addiction Treatment
Your TRICARE plan may cover inpatient treatment for an alcohol use disorder.
- If you need emergency inpatient treatment, TRICARE will cover detox, stabilization, and medications to help manage withdrawal and any medical complications that may arise. No referral or pre-authorization is required for emergency treatment; still, if you’re admitted for continued treatment, you’ll need authorization, and somebody must inform your regional contractor within 72 hours of admission.
- Treatment is considered non-emergency if you seek treatment on your own. TRICARE will cover detox and stabilization and may help cover treatment for depression, PTSD, or other co-occurring mental health issues. Prior authorization and referrals are required for all non-emergency inpatient treatment or residential rehab. Your regional contractor can provide specifics on authorization requirements.
You may have access to various levels of outpatient treatment, depending on your level of need. In most cases, authorization isn’t required for outpatient treatment, but you may need a referral before you get started.
- Standard outpatient treatment is often suitable for people with less severe addiction, and typically involves one visit to a treatment provider per week.
- Intensive outpatient (IOP) typically involves about six hours of treatment per week, which may be during the day, or evenings, nights, or weekends.
- Partial hospitalization (PHP), also known as day treatment, is the most intensive outpatient treatment. It involves attendance five to seven days per week, up to eight hours per day, but you’ll go home every night. Partial hospitalization works well for people who need a higher level of care (but not full-time), or have completed inpatient treatment.
Can I Use My VA Health Care Benefits With TRICARE?
Yes, you can use VA health care benefits along with your TRICARE plan; your TRICARE coverage doesn’t affect your VA healthcare benefits. The VA has behavioral healthcare programs in VA facilities across the United States, and most are TRICARE network providers.
However, veterans are the primary beneficiaries of VHA, and care at VA facilities is available to TRICARE enrollees on a space-available basis. Check with your regional contractor or the representative at your local VA healthcare facility for specifics on how VA benefits and TRICARE coverage work together. Also, note that requirements for pre-authorizations and referrals aren’t necessarily the same.
Don’t Wait to Get Started
We are proud to accept TRICARE at 1st Step Behavioral Health. Our treatment professionals will discuss your options and work with you to ensure you receive the best treatment for your particular needs. We can verify your benefits package immediately, and we’ll let you know if any prior authorizations are needed. Please pick up the phone and give 1st Step a call at (866) 971-5531 or contact us online.