What it means to us to be a TRICARE-Covered Rehab Facility

Last Updated: Jan 8th 2021

Reviewed by Brittany Polansky, MSW, LCSW

What it means to us to be a TRICARE-Covered Rehab Facility

Managed by the Defense Health Agency (DHA), TRICARE is a supplemental health care program that provides health benefits for active duty service members and their families. As civilian addiction and mental health providers, TRICARE-covered rehab facilities serve an important role by complementing healthcare services offered by military hospitals and other treatment facilities. 

Formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), TRICARE currently serves more than 9 million beneficiaries. Because it is so large, TRICARE consists of two large regions — TRICARE East, with services provided by Humana Military Healthcare Services, Inc., and TRICARE West, with services provided by Health Net Federal Services, LLC.  

TRICARE provides a variety of plans. For instance, TRICARE Prime is for members under age 65, while TRICARE for Life is for members age 65 and older who receive Medicare Part A and B. The company also offers Young Adult, Retired Reserve, Standard Overseas, Reserve Select, and Prime Remote.

How TRICARE Drug Rehabs Are Approved

TRICARE-covered rehab facilities are proud to meet the high standards of treatment established by TRICARE and the Department of Defense, and to serve military personnel, veterans, and their families. All rehab facilities must be certified and authorized according to TRICARE regulations and licensing requirements. The status of each rehab must be verified by TRICARE’s managed care contractors in each region. 

Network Providers: Rehab facilities and mental health providers approved to be part of TRICARE’s network must agree to provide services to members at a negotiated rate, which is accepted as payment in full. Rehabs must agree to accept the patient’s copay or coinsurance, and the rehab will collect the remaining amount directly from TRICARE. This agreement simplifies the process and keeps out-of-pocket expenses for patients at a manageable level.  

Non-Network Providers are treatment providers that opt not to sign a contract with TRICARE. However, such providers must still be certified. Non-network providers can choose to be “participating” providers or “non-participating” providers. 

Do your homework carefully if you’re thinking about seeking treatment from a non-network provider, as you may be required to pay a larger share of the costs. In addition to higher treatment expenses, you may be expected to pay up-front, depending on your plan’s specifics. You will probably be required to file claims with TRICARE, and you may have to wait for full or partial reimbursement of your payment.

  • Rehabs that opt to be non-network, participating providers agree that patients pay only copay or coinsurance and that TRICARE’s allowable charge is accepted as payment in full, even though they haven’t entered into a formal contract or agreement with TRICARE. Rehabs that choose to be participating providers also agree to file the claim for the patient. Call your insurance provider for more information if you’re a Medicare recipient.  
  • Rehabs that opt to be non-network, non-participating providers aren’t required to file claims for patients, and they don’t enter an agreement or contract to accept TRICARE’s allowable charge. Patients can get treatment at a non-participating rehab only if their plan includes out-of-network benefits, or if they are willing to pay for treatment. Non-participating rehabs can legally charge up to 15 percent more for services. For patients, this is generally the most expensive option.

TRICARE and the Affordable Care Act (Obamacare)

The Affordable Care Act (ACA), also known as Obamacare, was enacted to ensure that Americans have access to minimum essential health care coverage. The ACA also recognizes that quality treatment of substance abuse and mental health disorders is just as important as treating medical or physical problems. 

The ACA, passed in 2010 and put into action in 2014, is a means of improving healthcare quality and lowering medical expenses for American citizens. Nearly all TRICARE plans meet or exceed minimum ACA requirements, although specific coverage varies depending on your particular plan. 

In 2016 the Department of Defense (DOD) made significant changes that remove stigmas and improve access to treatment for substance abuse and mental health disorders for TRICARE members. Certain limits and barriers to treatment were loosened or removed, and copay and coinsurance amounts were adjusted to match cost-shares associated with medical treatments. 

As a result, addiction and mental health services became more accessible. Changes made by DOD also streamlined the process for rehab facilities to become TRICARE-authorized treatment providers.

Services Covered by TRICARE

TRICARE covers a wide range of treatment modalities, but an evaluation by a medical professional determines if treatment is medically necessary and which type of treatment or rehab is most likely to be effective. Don’t assume that all forms of treatment are covered. Although some treatments may be very beneficial for some people, they aren’t covered by TRICARE unless they are backed up by sound scientific research and evidence. Treatments that aren’t likely to be covered include equine therapy, acupuncture, aversion therapy, yoga, primal therapy, or biofeedback. 

Services frequently covered by TRICARE include:

  • Detox and withdrawal management
  • Certain medication-assisted treatment (MAT) programs
  • Residential or inpatient programs
  • Partial hospitalization programs (PHP)
  • Intensive outpatient programs (IOP)
  • Drug education and prevention
  • Medical screening
  • Medical emergencies
  • Co-occurring disorders that often underlie substance abuse, including PTSD, depression, anxiety, or bipolar disorder 
  • Psychiatric outpatient treatment
  • Psychiatric inpatient treatment
  • Counseling and therapy for family members
  • Office-based opioid treatment
  • Treatment for eating disorders
  • Smoking cessation programs
  • Drug take-back programs
  • Relapse prevention

You Deserve the Finest Care Available

At 1st Step, we accept TRICARE, and we’re honored to provide the highest quality services to men and women who have served our country, along with their dependents. Whether you’re concerned about substance abuse or dealing with issues such as PTSD, anxiety, or depression, our licensed, professional staff will help you get your life back on track. Treatment expenses are tricky to navigate, but we’ll help you understand your TRICARE plan and precisely what services are covered Give us a call at 855-425-4846 or contact us online

Reviewed for Medical & Clinical Accuracy by Brittany Polansky, MSW, LCSW

Brittany has been working in behavioral health since 2012 and is the Assistant Clinical Director at our facility. She is an LCSW and holds a master’s degree in social work. She has great experience with chemical dependency and co-occurring mental health diagnoses as well as various therapeutic techniques. Brittany is passionate about treating all clients with dignity and respect, and providing a safe environment where clients can begin their healing journey in recovery.