TRICARE Insurance for Alcohol Rehab

If you or a loved one is struggling with alcohol addiction, you may be wondering whether getting treatment, which can be costly, will help. Fortunately, most insurance plans, including TRICARE, offer some level of coverage for mental health and substance use treatment. Learn more about TRICARE, what it covers, and how to check your TRICARE benefits below.

What Is TRICARE?

TRICARE is a health insurance program for veterans and active-duty service members and their families.¹ TRICARE is currently managed by the Defense Health Agency and offers health insurance, pharmacy, and dental insurance coverage to all eligible enrollees across the globe.¹

To effectively manage all TRICARE plans, plans are split into 3 regions, with each region being managed by a separate contrator.² There are 2 domestic regions, called East and West, and a third overseas region. The overseas region covers eligible enrollees located in Canada, the Pacific area, Latin America, Africa, and Eurasia.² Where you’re located may dictate which TRICARE plans are available to you, as will your current military status.

What Types of Treatment Does TRICARE Cover?

Most TRICARE health plans meet the minimum essential coverage requirements set forth by the Affordable Care Act (ACA).¹ These 10 essential health benefits include mental health and substance use treatment.¹

Every person is different, and their addiction recovery treatment needs may vary, but some common treatment options TRICARE may cover include:^4,16

• Detoxification, which helps you more safely and comfortably manage alcohol withdrawal symptoms.
• Outpatient care, where you visit a facility for treatment at set times and go home at night. This can include standard outpatient, partial hospitalization (PHP), or intensive outpatient (IOP).
• Inpatient services, where you stay at a treatment center for the length of treatment and get 24/7 care and support.
• Co-occurring mental health and substance use treatment, which is treatment that treats any mental health and substance use disorders at the same time.
• Medicines for addiction treatment (MAT) combines prescription medicine and behavioral therapy to treat alcohol use disorder.

Does TRICARE Cover Alcohol Detox?

TRICARE plans will cover withdrawal management if you have a substance use disorder.⁴ Specifically, TRICARE covers inpatient services, intensive outpatient programs, partial hospitalization programs, and residential substance use disorder treatment.⁴ How much of the cost your plan covers may vary based on the plan you have and where you seek care.

Does TRICARE Cover Inpatient Rehab?

Depending on your specific plan, TRICARE will cover some of the costs for inpatient alcohol rehab.⁵ Specifically, TRICARE plans may cover emergency inpatient hospital services for detox, stabilization, and any medical complications that are related to a mental health or substance use disorder.⁵ TRICARE plans may also cover inpatient care for the diagnosis and treatment of mental health and substance use disorders.⁵

If you’re having an emergency, you do not need prior approval (called “pre-authorization”) to get services. But you may need pre-authorization for any ongoing care and non-emergency inpatient services.⁵

Does TRICARE Cover Outpatient Rehab?

What your TRICARE plan covers will vary based on your plan and location, but most plans cover some form of therapy, counseling, and MAT.⁶ As with inpatient programs, you may need to get a pre-authorization before starting treatment.

How to Check My TRICARE Insurance Benefits

When possible, checking your TRICARE mental health benefits before seeking care can help you avoid surprise medical bills. You can check your benefits a few ways:

• Log in to the patient web portal and view your summary of benefits and coverage.
• Call the customer service number on the back of your TRICARE card.
• Verify your insurance directly with your chosen rehab facility.

Types of TRICARE Insurance Plans

TRICARE offers many different plans depending on your current military status and where you live. These include:⁷

• TRICARE Prime. With this plan, you have a primary care manager (PCM) who coordinates all care, including specialist referrals and pre-authorizations. While you typically have less flexibility with TRICARE Prime, you will also have lower out-of-pocket costs.⁸
• TRICARE Select. With this plan, you have more options in who you see and often don’t need referrals. But you may pay higher costs and some services still need pre-authorization.⁹
• TRICARE for Life is for Medicare-eligible retirees and their families who have Medicare Part A and Part B.¹⁰ Generally, you’ll need to contribute to the cost of Medicare Part B premiums, but it can be used wherever Medicare is accepted.¹⁰
• TRICARE Retired Reserve. This plan covers certain retired service members under age 60 who are not covered by Federal Employees Health Benefits. As with Select plans, members of this plan may use non-network providers at a higher cost and don’t need referrals to see specialists.¹²
• TRICARE Young Adult. This plan covers eligible members after their regular TRICARE coverage ends at age 21 (23 if in college). To select this plan, you must also be under age 26, unmarried, and not qualify for health care through an employer. Members of this plan can select either the Prime or Select options outlined above.¹³
• US Family Health Plan offers coverage through networks of non-profit community care systems in some regions of the United States. Benefits of this plan include paying less out-of-pocket and the convenience of getting all your care through one local community system.¹⁷

Be sure to talk to a TRICARE representative to learn more about eligibility requirements. They can also explain what cost-sharing and out-of-pocket costs you may have. Some of the following out-of-pocket costs may apply:¹⁴

• This is a fixed dollar amount that you must pay each year before the insurance company makes payments toward your medical costs.
• This is a fixed amount you must pay for a service covered by insurance. For example, $30 for each doctor visit.
• After your deductible is met, you may still have to pay for a percentage of services—this is the coinsurance. You share the expense for services with the insurance company.
• Out-of-pocket maximum. This is the maximum dollar amount you’ll have to pay out-of-pocket toward medical expenses during each plan year. Once you’ve hit this limit, your insurer pays for any covered services.

Does TRICARE Cover Out-of-Network Providers?

Depending on your health plan with TRICARE, you may be required to visit in-network providers. But some TRICARE plans allow you to seek care outside of your network of covered providers. Be sure to talk to a TRICARE representative to understand what your plan allows for to help keep your health care costs as low as possible.

How Can I Pay Costs Not Covered by TRICARE?

If your TRICARE plan doesn’t cover all the costs associated with veteran alcohol rehab, you may be responsible for the remaining costs. While you may be able to pay for them out-of-pocket, there may also be alternative payment options available to you. Be sure to ask the rehab center whether any of the following would apply to you:

• Sliding scale fees: A rehab facility may offer different rates based on income if you have to pay out-of-pocket.
• Payment plans: Many rehab centers can arrange payment plans to help you spread out the costs.
• Grants: The Substance Abuse and Mental Health Services Administration (SAMHSA) offers federal grants to certain populations to help people pay for treatment.¹⁵

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