If you’re covered by a TRICARE health insurance plan, and you or a dependent is struggling with substance abuse, it’s important to know if rehab is covered. Thankfully, TRICARE drug rehab coverage does exist.
Does TRICARE Cover Drug Rehab?
Yes TRICARE covers drug and alcohol rehabilitation! TRICARE substance abuse coverage is pretty broad, and like all insurance companies, coverage will be specific to the plan type you have.
Detoxification and withdrawal
Drug detox can be relatively mild or very difficult, but it’s common for people to experience unpleasant symptoms. Depending on your needs, you may undergo detoxification at a treatment center, detox clinic, or a hospital. Even if you don’t need emergency detox, medical care will ensure you’re safe and comfortable. Quitting at home isn’t wise, especially if you live alone.
Inpatient (residential) treatment offers the best form of care 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 covers emergency services that include detoxification and stabilization, including any medical complications from your substance abuse disorder. Emergency services do not need prior authorization, but you do need approval for continued treatment.
TRICARE also offers non-emergency coverage that includes the diagnosis and treatment of mental health and substance use disorders. Private psychiatric hospitals as well as local, state, or federal government psychiatric hospitals are typically included in coverage. Non-emergency inpatient services do require prior authorization.
Residential treatment programs
Residential treatment programs are often best with those with a dual diagnosis of substance abuse and some kind of psychiatric disorder.
With TRICARE insurance, you do need prior authorization before entering a residential treatment program. You also have to be under the age of 21 and have been already diagnosed with a co-occurring mental health disorder.
Partial hospitalization programs (PHP)
PHP is designed for people who have a substance use or mental health problem 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 hospitalizations.
Medication-assisted therapy (MAT)
MAT is an effective treatment 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.
TRICARE Covered Rehab Facilities
Even though not all TRICARE covered substance abuse services need a prior-authorization, check above to see what services you’re interested in, and what the requirements are. They also offer a variety of telehealth services that can potentially help you get the prior-authorizations you need more quickly. Once you have your pre-auth (if needed) you can start looking for TRICARE rehab facilities that are right for you.
1st Step Behavioral Health Takes TRICARE
First Step Behavioral Health in South Florida is happy to accept patients that are covered by TRICARE. Our substance abuse treatment providers can work with you to find the right drug rehab program for you, and make sure every step of your treatment is looked at so that you can feel at ease that the services are covered.