For those seeking recovery from addiction, TRICARE insurance covers various levels of addiction treatment. From controlling withdrawal symptoms to detox and continued medication-assisted treatment, plans from this insurance provider make most types of addiction recovery methods accessible and affordable. TRICARE insurance enrollees can seek the help they need to fully recover from drug and alcohol addiction for life.
As with all insurance plans, the different levels of coverage are subject to eligibility restrictions and other limitations. To take the first steps toward recovery, TRICARE clients can explore the available coverage for drug and alcohol addiction treatment.
Does TRICARE Cover Drug And Alcohol Detox?
Patients who seek addiction recovery services from qualified medical centers may have drug and alcohol detoxification services covered by their TRICARE insurance plan. Both the medical care and medications received in approved drug and alcohol detox programs fall under the detox category if used to control withdrawal symptoms.
Drug and alcohol detox coverage kicks in when TRICARE clients enroll in the approved inpatient or outpatient care program. Residential and partial hospitalization settings also qualify as medical centers authorized to bill for detoxification services.
Does TRICARE Cover Inpatient Rehab?
As long as all conditions have been met, TRICARE offers coverage for both urgent and non-emergency inpatient care for addiction treatment. For example, TRICARE clients must exhibit a psychiatric or medical emergency relating to addiction that requires immediate hospitalization to meet the conditions for urgent care.
If patients experience addiction requiring emergency hospitalization in an inpatient treatment center, TRICARE will offer coverage for that immediate need and beyond. Non-emergency care is also covered if the patient seeks care on their own from a qualified treatment center.
In most cases, insurance coverage applies throughout the detoxification and stabilization process. In addition, TRICARE insurance covers the diagnosis and treatment of complications arising from short- or long-term drug and alcohol addiction.
Does TRICARE Cover Intensive Outpatient Rehab?
TRICARE covers intensive outpatient rehab when patients meet their plan’s qualification requirements. Patients must be suffering from active addiction, yet not have a need for round-the-clock care in a hospital setting. TRICARE clients may not need to acquire prior authorization before seeking care from an intensive outpatient rehab center.
Those suffering from a substance use disorder may also qualify for intensive outpatient rehab while transitioning from an inpatient addiction treatment program. Treatment of co-occurring disorders, such as mental health conditions, also falls under the coverage for outpatient treatment programs.
Outpatient addiction treatment provides therapy to address the issues underlying the addiction and to help patients develop the relapse-prevention skills necessary for long-term recovery.
Does TRICARE Cover Medication-Assisted Treatment?
TRICARE clients diagnosed with an opioid use disorder may qualify for medication-assisted treatment coverage. This type of treatment includes mental health therapies in addition to medications to prevent withdrawal and discourage relapse.
Patients may not need to seek prior authorization for medication-assisted treatment when acquiring care from a TRICARE-authorized treatment center or healthcare provider. To qualify, the drug and alcohol rehab facility must have authorization from the Drug Enforcement Agency to prescribe and monitor the use of medications such as Suboxone (buprenorphine and naloxone) or methadone.
Does TRICARE Cover Sober Living Houses?
TRICARE coverage for sober living houses may fall under coverage for partial hospitalization programs. These programs help those suffering from addiction to reach recovery while continuing to receive medical support services. These facilities do not provide 24-hour care but do offer a sober living environment for those who are new to recovery and need additional time to develop their relapse-prevention skills.
Patients must demonstrate an inability to reach and maintain recovery with outpatient services. The level of impairment caused by addiction must significantly interfere with normal everyday functioning to activate partial hospitalization coverage for sober living houses.
In-Network Versus Out-Of-Network Care
Although TRICARE plans tend to cover treatments and procedures based on proven medical necessity, patients must select providers approved by TRICARE. Participating in-network providers have a pricing agreement with TRICARE for billing addiction treatment services. Patients of in-network addiction treatment facilities are only responsible for a portion of the cost as an out-of-pocket expense.
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Patients enrolled in the TRICARE Select, Reserve Select, Retired Reserve, Young Adult Select and Prime Remote plans are permitted to use the out-of-network provider of their choice. If patients choose out-of-network care, however, they may have to file their own claims and pay a higher percentage of the service cost.
Out-of-network providers may charge up to 15 percent more than the allowable charge, though some may set their rates below the allowable charge. In some cases, TRICARE clients must cover the full cost of out-of-network services and then seek reimbursement from the insurance company after the fact.
Patients seeking drug and alcohol rehab can contact their preferred treatment centers to run a verification of benefits. This process may reveal that an out-of-network provider offers the most affordable rate, despite their lack of participation in the TRICARE program.
How To Find Drug And Alcohol Rehab Centers That Accept TRICARE
- Call Addiction Campuses for immediate verification of benefits. Addiction Campuses can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.
- Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.
- Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.