TRICARE Drug Rehab Coverage

Does TRICARE Cover Drug Rehab?

Yes, TRICARE insurance covers addiction treatment and mental health services. Like other insurance companies, the extent of your coverage depends on the specific plan you have, your deductible, or other factors.

Types of treatment TRICARE may cover include:

Detox

Drug detox can range from mild to severe, and it usually comes with unpleasant symptoms. Depending on your needs, you can detox at a treatment center, detox clinic, or in a hospital. It’s smart to have medical help, even if it’s not an emergency, to keep you safe and comfortable. Quitting on your own at home, especially if you’re alone, isn’t a good idea.

Fortunately, your TRICARE insurance will cover medical detox services as well as the medications used. TRICARE covers emergency services that include detoxification and stabilization, including any medical complications from your substance use disorder. Emergency services do not need prior authorization, but you do need approval for continued treatment.

Inpatient treatment

Inpatient (residential) treatment is best for people with severe or long-term addictions. It is also useful for people with unstable home situations or those who also need help for depression, anxiety, or other mental health issues. If you enter inpatient treatment, you’ll be in a more structured environment than outpatient treatment. You receive more counseling and therapy, as well as housing, meals, medical care, and certain recreational activities.

TRICARE offers non-emergency coverage that includes the diagnosis and treatment of mental health and substance use disorders on an inpatient basis. Private psychiatric hospitals as well as local, state, or federal government psychiatric hospitals are typically included in coverage. However, non-emergency inpatient services do require prior authorization before entering a residential treatment program. You also have to be under the age of 21 and have already been diagnosed with a co-occurring mental health disorder.

Partial hospitalization programs (PHP)

PHP is designed for people who have substance use or mental health problems but don’t need inpatient or full-time rehab. Partial hospitalization programs also work well for people who have completed inpatient treatment but aren’t yet stable enough to meet the demands and stresses of everyday life.

With TRICARE, prior authorization is not needed to enter a PHP, but you must seek treatment in the U.S.

Intensive outpatient programs (IOP)

IOP is often recommended for people who don’t require rehab full-time but need more care than they would receive from regular outpatient treatment. Intensive outpatient treatment typically involves at least three visits per week. It is often a middle step for people who have just completed residential treatment but aren’t quite ready for regular outpatient.

With TRICARE, you need to check with your regional plan advisor for whether or not a prior authorization is needed for IOP services. They do offer coverage for those transitioning into IOP from other types of substance abuse treatment programs, like inpatient rehab

Medication-assisted treatment (MAT)

MAT is an integrated approach that combines regular therapy and counseling with certain medications. TRICARE may cover both standard and office-based opioid treatment but requires providers to be authorized and certified by the Drug Enforcement Administration (DEA) to prescribe buprenorphine.

With TRICARE, Prior Authorization is not needed for MAT TRICARE coverage, but First Step Behavioral Health does not offer MAT.

TRICARE does not provide drug and alcohol rehab coverage for aversion therapy (a form of behavior modification that can sometimes trigger anxiety, anger, and hostility), or treatment programs that have not been medically proven and backed up by research.