TRICARE is the healthcare insurance program that covers uniformed service members, retirees, as well as their families.
All About TRICARE Coverage, What are the 3 types of TRICARE?, Does TRICARE Cover Residential Addiction Treatment?, , Does TRICARE Cover Outpatient Rehab?, Does TRICARE Cover Inpatient Mental Health?, What Addiction Treatment Services are Covered by TRICARE?, What is Not Covered by TRICARE Prime?, Does TRICARE Cover 100 percent?, What Meds Does TRICARE Not Cover?, Is TRICARE Considered Good Insurance?
Whether they are active or retired, military members are widely respected amongst the US population. Despite the many benefits of being in the military like being able to travel the world and meet people from all walks of life, it also comes with several disadvantages.
For example, military members may be deployed into an active war zone and be exposed to traumatic events that can haunt them for the rest of their life. It is possible for their physical and mental health to suffer as a result.
Substance abuse disorders and post-traumatic stress disorders (PTSD) are common among military members, both active and retired. They try to cope with the stress and the resulting mental illnesses by self-medicating and misusing drugs. This is why mental health treatment is a huge concern for anyone who has been through a war-like environment.
Active-duty service members and retired service members alike should understand how TRICARE insurance works. TRICARE beneficiaries have a range of health plan options available to them depending on what services they need and where they live.
Here we will be discussing TRICARE: everything you need to know about TRICARE coverage, TRICARE plans, and benefits. We will focus on addiction treatment coverage and how those who are struggling with addiction can make use of TRICARE.
All About TRICARE Coverage
TRICARE is the healthcare insurance program that covers uniformed service members, retirees, as well as their families. Managed by the Defense Health Agency, this program gives comprehensive coverage to all of its beneficiaries around the world. This includes health plans, prescriptions, dental plans, and other special programs.
Most health plans offered by TRICARE successfully meet the requirements for minimum essential coverage under the Affordable Care Act.
TRICARE’s mission is to enhance the Department of Defense (DOD) as well as the nation’s security by providing health support for military personnel. They provide a high level of care to almost 10 million active and retired members of the military, along with their dependents.
This program began in the 1990s. It was named TRICARE because it only had three plan options at the time. The program evolved over time, of course, and it began to include coverage for a much broader spectrum of needs and benefit categories.
The two main categories of beneficiaries under TRICARE are sponsors and family members. Sponsors are active duty and retired personnel, along with National Guard/Reserves members. Family members are dependents who are registered in the Defense Enrollment Eligibility Reporting System or DEERS. The two categories have different sets of plans and benefits available to them.
Keep in mind that not all veterans are covered by TRICARE. While all retired members are eligible, separated service members are generally not TRICARE-eligible. The one notable exception to this rule are Medal of Honor recipients and their families.
What are the 3 types of TRICARE?
When the Department of Defense introduced TRICARE in the 1990s, there were only three types of plans, hence the name. There were plan variations like TRICARE Standard and TRICARE Extra. These have come and gone. The program has evolved since then.
Now there are plenty of health and dental plan options to provide the needs of military members around the world.
TRICARE Prime has four different plans. All active-duty military members need to enroll in one of these four TRICARE Prime options at no cost. There’s TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, and TRICARE Prime Overseas Remote.
TRICARE Prime is similar to a civilian plan, but it has a few significant differences. Civilian Health Maintenance Organization (HMO) plans usually allow their enrollees to choose a Primary Care Physician (PCP) who coordinates their care. On the other hand, TRICARE Prime enrollees get a Primary Care Manager (PCM) assigned to them. So unless the Military Treatment Facility (MTF) lacks the capacity to take care of them, Prime enrollees will get their treatment at an MTF.
With TRICARE Prime, there are no out-of-pocket charges to active-duty service members for medical services. They also don’t have to file claims. There are also no copays for covered drugs as long as they use a TRICARE Pharmacy Home Delivery or Military Pharmacy.
TRICARE Prime Remote, also known as TPR, is only available to active duty service members and activated Guard/Reserves. This also extends to their family members. The only difference with Prime is that it allows you to choose your own PCM as long as it is TRICARE-authorized.
TRICARE Prime Overseas is like Prime wherein you are assigned a PCM who will handle your care at an MTF. Health care provided by or through the PCM has no cost. However, if you use the point-of-service option, there will be fees.
Finally, TRICARE Prime Overseas Remote assigns a PCM who gives health care outside of the MTF system. There is also no cost, but fees may be applicable if you use the point-of-service option.
The main difference between these plans is where the treatment centers are located. Some are done in an MTF setting, while others are not.
Family members and beneficiaries typically have other choices like TRICARE Select. However, a TRICARE Prime plan is usually the most affordable option.
Does TRICARE Cover Residential Addiction Treatment?
You may be wondering if TRICARE covers things like inpatient rehab, since drug addiction, alcohol addiction, and other substance use disorders are so common among those who have experienced trauma.
TRICARE insurance actually covers drug and alcohol rehab treatment. If you are covered by TRICARE, you may be eligible for a wide range of substance abuse treatment programs. Many treatment centers accept TRICARE, including American Addiction Centers.
Do take note that the exact rehab coverage depends on the specific provider along with the TRICARE member’s health plan. Other variables may also come into play.
If you need immediate hospital admission, or you have some sort of medical or psychiatric emergency, TRICARE may cover these emergency inpatient rehab services. Under TRICARE, you will get treatment at the closest available hospital that can give you the treatment you need.
If treatment is medically necessary, TRICARE will cover any therapy. The purpose of the therapy must be to improve, restore, maintain, or prevent the deterioration of function. Therefore this could apply to substance use disorders.
The meaning of “medically necessary” simply refers to the fact that treatment must be reasonable, adequate, and appropriate for the person’s condition. It has to be necessary for the establishment of a safe maintenance program that will effectively tackle the patient’s medical condition—in this case, their substance abuse.
Therapy has to be rendered by an authorized rehab service provider and needs to be provided at a skilled level. However, TRICARE will not pay for custodial care. This refers to personal care for basic day-to-day tasks.
Does TRICARE Cover Outpatient Rehab?
Certain outpatient treatment programs are covered by TRICARE, such as Partial Hospitalization Programs (PHP) for psychiatric and substance use disorders. TRICARE coverage includes authorized PHP facilities for both substance use disorders and mental health problems.
Outpatient treatment is only suitable for those with mild to moderate conditions, particularly those who do not need round the clock care from medical professionals. They are not at risk of medical complications, and they have responsibilities in the outside world that they cannot leave behind.
Since they do not have to be in a hospital full time, they are free to pursue other endeavors even while receiving addiction treatment. Outpatient treatment is perfect for those with strong support systems at home.
If you have a mental health or substance use problem and are seeking outpatient treatment in the US, you may be covered by TRICARE.
Does TRICARE Cover Inpatient Mental Health?
Yes, TRICARE covers various services for mental health disorders because these are common struggles for those who have served in the military, especially those who have witnessed combat.
TRICARE covers inpatient and outpatient services including therapy and counseling. This includes individual sessions, group sessions, and family therapy sessions. Psychotherapy and psychoanalysis are both covered.
TRICARE even covers psychological testing that helps diagnose patients so that they can get a personalized treatment plan based around their specific needs. However, it does not cover psychological testing for the purposes of academic placement.
Medication-assisted treatment and ancillary therapies may also be covered for patients struggling with substance use disorder.
For ancillary therapies, TRICARE only covers those that are part of a treatment plan at one of the following inpatient facilities: a psychiatric residential treatment center, a residential drug treatment center, a partial hospitalization program, and an intensive outpatient program.
TRICARE may cover certain therapies such as art therapy, music therapy, dance therapy, occupational therapy, etc.
What Addiction Treatment Services are Covered by TRICARE?
You may be surprised by the number of addiction treatment services that are currently covered by TRICARE.
This includes inpatient services, both emergency and non-emergency, for those who need round the clock support for their withdrawal symptoms.
Medical detox, also known as detoxification, is also covered. This should help people who are suffering from the physical effects of addiction and drug dependence. This involves gradually lowering their intake while their withdrawal symptoms are managed.
TRICARE also covers medication-assisted treatment, opioid treatment programs, and residential substance use disorder treatment.
For those who don’t require inpatient care, TRICARE also covers intensive outpatient programs and partial hospitalization programs.
What is Not Covered by TRICARE Prime?
Of course, TRICARE has several exclusions that you should take note of. Services and supplies that are not medically or psychologically necessary for the treatment or diagnosis of a covered illness are excluded.
Here are some noteworthy exclusions: acupuncture, alternative treatments, assisted living facility care, aversion therapy, autopsy services, blood pressure monitoring devices, cosmetic drugs, dry needling, dyslexia treatment, mind expansion psychotherapy, exercise equipment and programs, chair lifts and elevators, experimental procedures, gym memberships, herbal drugs, LASIK surgery, massage, multivitamins, naturopathic care, nursing homes, paternity tests, private hospital rooms, retirement homes, unproven procedures, and vision therapy. This list is not all inclusive.
Does TRICARE Cover 100 percent?
Certain prescription drugs and medications are not covered by TRICARE. Drugs that are listed in the non-covered category are automatically excluded. Drugs that treat a non-covered condition are also excluded.
TRICARE does not cover drugs that are prescribed for cosmetic purposes. Also excluded are multivitamins, fluoride preparations, homeopathic preparations, herbal preparations, and certain over-the-counter products.
Although you are able to get prescriptions for these excluded drugs, you will have to pay for the full cost yourself.
Is TRICARE Considered Good Insurance?
For military personnel, both active-duty and retired, TRICARE is an excellent insurance that covers a wide range of treatment programs. It provides some of the most affordable healthcare options in the US.
A lot of primary, preventative, and hospital care are covered. Use TRICARE’s search feature to find out what is covered under your plan. You can also use this feature to review what services are excluded. As a rule of thumb, services that are not medically necessary are generally excluded.