Does TRICARE Cover Alcohol Rehab?

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. 

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 855-425-4846 or contact us online

TRICARE Mental Health Coverage for You & Your Dependents

TRICARE covers mental health care for active-duty military service members, retirees, and their families. Although coverage is wide-ranging and comprehensive, specifics vary depending on your TRICARE plan and your location. Some services may require a referral or preauthorization.

Does TRICARE Cover Mental Health Treatment?

Yes! TRICARE covers treatment for mental health issues in a wide range of settings. However, the level and type of care depend on the severity of the problem and other factors. 

Inpatient treatment: TRICARE covers inpatient treatment only when provided by a TRICARE-authorized hospital or substance use rehab facility. If you believe you or a family member need inpatient treatment, make an appointment with your primary care provider, and request an assessment. You’ll need a referral and preauthorization for all non-emergency mental health treatments. 

Emergency treatment: Call 911 immediately or go to the nearest emergency room if your or a family member is at risk of harming himself or others or needs skilled, around-the-clock care. You don’t need preauthorization for emergency mental health treatment, but if you are admitted for further care, you must report the admission to your regional contractor within 72 hours.

Acute inpatient care: If mental health disorder creates a risk to self or others, and around-the-clock care is needed, a medical provider may refer the person to acute inpatient treatment. 

Residential treatment: A medical provider may recommend this form of inpatient treatment for children and adolescents with a diagnosed mental health disorder. The facility must be authorized by TRICARE, and you’ll need a referral and preauthorization. Residential treatment is useful for youth who need structured care until they are stable and can continue with regular outpatient treatment. A youth in crisis may need emergency treatment or acute inpatient care.

Partial hospitalization (PHP): People who are partially stabilized and don’t need full-time, inpatient treatment often benefit from partial hospitalization. PHP generally involves attending a mental health or substance use treatment facility five to seven days per week, up to eight hours per day. This treatment may not be available in areas outside the U.S. and its territories. 

Outpatient treatment: In most cases, you don’t need prior authorization for outpatient treatment from a TRICARE-authorized provider. If you want to work with a pastoral counselor, you must get a referral first, and a medical provider must supervise treatment, even if the counselor is in the TRICARE network. 

Psychotherapy: TRICARE covers inpatient and outpatient counseling or psychotherapy for individuals, families, and groups when treatment is psychologically or medically necessary. Treatment must be provided by a TRICARE-approved provider, limited to no more than two sessions per week, and only one session of the same type in a single day. 

  • Individual therapy: TRICARE covers psychotherapy sessions lasting up to 60 minutes, and up to 120 minutes for crises.
  • Family therapy: TRICARE covers sessions lasting up to 90 minutes, and 180 minutes for crises.
  • Group therapy: TRICARE covers sessions lasting up to 90 minutes.

Psychoanalysis: This type of specialized, long-term therapy aims to explore repressed emotions to gain a deeper understanding of troublesome thoughts and behaviors. Therapists must be approved by TRICARE and must have special training in psychoanalysis. Preauthorization is always required. 

Medication: TRICARE may cover medications as part of a treatment plan when prescribed by an authorized medical or mental health provider.

Psychological testing and assessment: TRICARE may cover psychological testing and assessment in some situations when deemed psychologically or medically necessary. However, TRICARE doesn’t cover:

  • Job or academic placement
  • General screening
  • Child custody disputes
  • Referrals by teachers or parents
  • Testing for learning disabilities or learning disorders

Does TRICARE Cover Online Therapy?

Yes, TRICARE covers many telehealth services, but some are available only during the Covid-19 pandemic. Check with your mental health provider to see if they have telehealth capability and what services are available. Also, contact your regional contractor for specifics; you may need a referral or authorization.   

What Will TRICARE Mental Health Treatment Cost?

You may be responsible for a copayment or cost-share percentage, but the cost varies substantially, depending on the type of treatment, your location, and your TRICARE plan. You can minimize expenses with treatment provided by a military clinic or hospital or a TRICARE network provider. 

Active duty service members pay nothing for mental health treatment provided or authorized by military clinics or hospitals. If you receive care from a civilian mental health provider, you must first get a referral and prior authorization. Keep in mind that treatment will almost certainly be more expensive. 

Reach Out for Help Today

At 1st Step, we are proud to partner with TRICARE, and we are here for you. Let us lend a helping hand as you explore the issues affecting your life. For a confidential consultation or verification of your TRICARE plan, give us a call at 855-425-4846 or contact us online.

Does TRICARE Cover Suboxone Treatment?

If you, or a dependent, is struggling with an opioid addiction and have TRICARE health insurance, Suboxone treatment is covered.

TRICARE Suboxone Treatment Coverage Details

TRICARE buckets Suboxone treatment coverage under Medication Assisted Treatment (MAT) — which includes the coverage of services that combine drug and mental health therapies to treat substance abuse. However, not all physicians that prescribe buprenorphine (the generic name for Suboxone) are covered by TRICARE; they must be authorized. Prescribers have to have completed training and certification set forth by the Department of Health and Human Services (HHS), the U.S. Drug Enforcement Administration (DEA), and state and local government. TRICARE MAT coverage includes two types of opioid substance abuse programs that typically include the use of Suboxone; opioid treatment programs and office-based substance use disorder treatments.

Opioid Treatment Programs

Opioid treatment programs (OTP) are covered by TRICARE when an authorized provider deems it necessary for a patient to be enrolled in a comprehensive detox program that is supported by medication therapy and mental health services. Covered OTP treatment can include both opioid detoxification and medically managed withdrawal from maintenance medications. OTP care is generally only covered and available for TRICARE members based in the U.S. and U.S. territories.

Office-Based Substance Use Disorder Treatment

Office-based Suboxone treatment programs are covered by TRICARE when the providers have been authorized according to TRICARE requirements. These are generally covered for members based in the U.S. and overseas — pending compliance with the host country’s specific licensure or certification requirements for providers. 

Talk to a TRICARE representative to determine referral and prior authorization requirements, which may vary depending on your specific plan, location, and other factors.

How Do I Start Taking Suboxone?

TRICARE requires that Suboxone treatment is accompanied by mental health therapy. SAMHSA (Substance Abuse and Mental Health Services Administration) reports that the combination of medication and therapy has proven to be effective for people suffering from opioid use disorders. 

Generally, a physician will evaluate your situation and will determine the best course of action. He may recommend that you enter medically managed detox to ensure you are as safe as possible while the drug leaves your body. The doctor will also work with you as you transition from your current opioid drug to Suboxone and manage your continued use of Suboxone. 

You’ll take the first dose of Suboxone between 12 and 48 hours after your last dose of an opioid drug, or when you begin to experience mild to moderate withdrawal symptoms. Starting Suboxone too early can trigger severe withdrawal symptoms. 

Withdrawing from Suboxone

With the use of Suboxone as an effective opioid addiction treatment, there’s always the concern of what to do when withdrawing from the drug. Ideally, you don’t want to be on Suboxone forever, and when the time comes to remove Suboxone from your addiction treatment plan, there’s typically two ways to withdrawl; through a taper or through a direct detox.

Through a taper, most people begin with a daily dose of Suboxone, gradually decreasing to a dose every other day. Depending on your needs, you may stay on this dosage or gradually move to a monthly maintenance dose. Suboxone isn’t intended for “as needed” or occasional use.

If you come to First Step for Suboxone, we will discuss all options as we curate your specific addiction treatment program plan. 

1st Step Accepts TRICARE Coverage, but We Don’t Offer Medication-Assisted Treatment

At First Step Behavioral Health, we accept TRICARE health insurance but we do not offer Suboxone treatment programs.

We do take a holistic approach to care, and screen all our clients for dual diagnosis to make sure we’re treating any mental or behavioral health issues along with drug addiction. We offer a variety of different types of substance abuse programs including drug detox, residential treatment, partial hospitalization, inpatient rehab, outpatient rehab, and mental health services. 

For more information about 1st Step Behavioral Health treatment options or to make an appointment to talk to one of our compassionate, knowledgeable counselors, please call (855) 425-4846 or contact us online