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TRICARE Coverage

TRICARE beneficiaries have a wide range of health plan options based on where they live and what services they need.

TRICARE Mental Health Providers, What are the 3 types of TRICARE?, TRICARE & Mental Health Services, Do You Need a Referral for Mental Health Care with TRICARE Prime?, How Many Mental Health Counseling Visits Does TRICARE Cover?, How Do I See a Psychiatrist with TRICARE Prime?, What is Not Covered by TRICARE Prime?, Does TRICARE Cover 100 Percent?, What Meds Does TRICARE Not Cover?, Is TRICARE Considered Good Insurance?, What does TRICARE Cover and Not Cover?


In the United States, military members are widely respected, whether they are active or retired.

However, it is no secret that military personnel are exposed to a lot of risky and dangerous scenarios that can even be traumatic. Despite the benefits of being in the military, there is no doubt that it also comes with its disadvantages.

Those who are deployed into an active war zone and experience combat are likely to experience traumatic events that can haunt them for the rest of their life. It is completely possible for them to suffer both physically and mentally.

This is why TRICARE covers a lot of the physical and mental health needs of military members. Post-traumatic stress disorder is common among active and retired military members alike. Some end up abusing substances like drugs and alcohol to cope with their condition. Mental health care is very important for anyone who has been through a war-like situation.

It is important to understand how TRICARE insurance works. TRICARE beneficiaries have a wide range of health plan options based on where they live and what services they need.

Here we will be focusing on the mental health care aspect of TRICARE insurance. We will talk about how active-duty military service members, retirees, and their families can enjoy the benefits of TRICARE insurance and work with mental health professionals.

TRICARE Mental Health Providers

TRICARE is the healthcare insurance program of the Department of Defense (DOD) that covers uniformed service members, retirees, and their families. It is managed by the Defense Health Agency, and provides comprehensive coverage to all of its beneficiaries around the world.

TRICARE offers health plans, dental plans, prescriptions, special programs, and even mental health care for its beneficiaries. Most of the health plans offered by this program meet the requirements for minimum essential coverage under the Affordable Care Act.

TRICARE ensures that military members can receive a high level of care. They provide coverage for nearly 10 million active and retired members of the military, along with their dependents.

Established in the 1990s, TRICARE got its name from the fact that it only had three plan options at the time. Over time, the program evolved to include coverage for an even broader spectrum of needs and benefit categories.

Do take note that not all veterans are covered by TRICARE. All retired members of the military are eligible, however, separated service members are generally not TRICARE-eligible. The one exception to this rule are Medal of Honor recipients and their families.



What are the 3 types of TRICARE?

The Department of Defense introduced TRICARE in the 1990s. At first it only had three types of plans including TRICARE Standard and TRICARE Extra, but the program has grown a lot over the years.

Now TRICARE offers plenty of health plan options for military members around the world. It has four different plans: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, and TRICARE Prime Overseas Remote. Active-duty military members need to enroll in one of these four options at no cost.

Family members and beneficiaries typically have other choices like TRICARE Select. Generally speaking, TRICARE Prime is the most affordable option.

TRICARE & Mental Health Services

TRICARE does cover a wide range of mental health services since these are common problems for those who have served in the military. TRICARE insurance covers inpatient and outpatient services such as counseling and therapy to help those who are dealing with mental illness. Individual therapy sessions, group therapy sessions, and even family therapy sessions are covered. The same goes for psychotherapy and psychoanalysis.

This insurance program even covers psychological tests that help diagnose patients. It allows them to receive a personalized treatment plan that revolves around their specific needs. Psychological tests that are only for academic placement are not covered.

Medication management and medication-assisted treatment for mental health conditions are covered by TRICARE. Certain ancillary therapies for psychiatric disorders are also covered as long as they are part of a treatment plan in one of these facilities: a residential drug treatment center, a psychiatric residential treatment center, a partial hospitalization program, or an intensive outpatient program. Depending on the program, TRICARE may even cover certain therapies like music therapy, art therapy, dance therapy, and occupational therapy, as long as it helps the person’s mental health.

Do You Need a Referral for Mental Health Care with TRICARE Prime?>

Whether or not you need a referral for mental health care depends on the type of treatment program.

For inpatient treatment, TRICARE covers this type of mental health program only if it is provided by a TRICARE-authorized hospital or rehab center. You have to make an appointment with your primary care provider and request an assessment if you or someone you love is in need of inpatient treatment.

For all non-emergency mental health care treatments, you need to secure a referral and preauthorization.

Other mental health professionals may recommend residential treatment for those who have been diagnosed with mental health disorders. The facility still needs to be authorized by TRICARE, and you still need a referral and preauthorization. But residential treatment can be beneficial for those who need a stable and comfortable environment where they can just focus on their recovery.

Some mental health issues are urgent to the point where they require emergency treatment. If someone is at risk of harming himself or others, call 911 immediately or visit the nearest emergency room. For emergency mental health treatment, preauthorization is not necessary. However, if you are admitted for further care, you have to report it to your regional contractor within 72 hours.

You also do not need prior authorization if you are going for an outpatient treatment program from a TRICARE-authorized provider. For those who want to work with a pastoral counselor, a referral is needed—plus a medical professional must be there to supervise the treatment.

For psychoanalysis, therapists must be approved by TRICARE or have special training in the field of psychoanalysis. In this case, preauthorization is always required.

Credentials are very important. TRICARE wants to make sure that healthcare providers are following clinical practice guidelines for behavioral health. Professionals need to get accredited first before they can provide treatment. For example, the American Nurses Credentialing Center (ANCC) credentials organizations and individuals who advance nursing. These are the kinds of healthcare providers who are preferred by TRICARE when it comes to the treatment of their members.


How Many Mental Health Counseling Visits Does TRICARE Cover?

For psychotherapy, TRICARE covers both inpatient and outpatient counseling sessions but only when treatment is medically or psychologically necessary. If so, they will cover individual, group, and family therapy sessions as long as treatment is provided by a TRICARE-approved provider. It also needs to be limited to no more than two sessions per week and only one session of the same type per day.

For individual therapy, TRICARE will cover therapy sessions lasting up to 60 minutes. For crises, this is increased to 120 minutes.

For group therapy, TRICARE will cover therapy sessions up to 90 minutes.

Finally, for family therapy, TRICARE will cover therapy sessions lasting up to 90 minutes. For crises, this is increased to 180 minutes.

The cost may vary substantially, and you may be responsible for copayment or cost-share percentage, depending on your location, the type of treatment, and your TRICARE plan. Expenses can be minimized using treatment provided by a military clinic or TRICARE-approved health care providers.

For active duty service members, they don’t have to pay anything for mental health care provided or authorized by military hospitals or clinics. For those who receive care from a civilian mental health care provider, you must first get a referral and prior authorization.

How Do I See a Psychiatrist with TRICARE Prime?

If you want to receive mental health care using TRICARE, first you have to determine whether the situation is an emergency or not. An emergency is if the patient who has a mental health disorder is at immediate risk of serious harm to themselves or to other people.

It is also an emergency if the person requires immediate and continuous observation based on a psychiatric evaluation. Call 911 or visit the nearest hospital emergency room if you have this type of emergency. They will provide immediate medical attention to the patient.

Emergency situations like this do not require pre-authorization. However, if the patient is admitted, you need to contact your regional contractor within 24 hours or the next business day. It needs to be reported within 72 hours.

For non-emergency cases, you do not need to get a referral or preauthorization for outpatient mental health care, excluding psychoanalysis. Take note that if you choose a treatment provider outside of the TRICARE network, you may have to pay more out-of-pocket.

Psychoanalysis or mental health care from a provider outside of a military clinic or hospital requires a referral.

What is Not Covered by TRICARE Prime?

TRICARE has a few exclusions that you need to keep in mind. There are certain supplies and services that are not considered medically or psychologically necessary for the treatment of mental health conditions.

Examples of noteworthy exclusions from TRICARE are the following: acupuncture, assisted living facility care, autopsy services, cosmetic drugs, dyslexia treatment, exercise equipment, chair lifts, elevators, gym memberships, LASIK surgery, multivitamins, nursing homes, private hospital rooms, vision therapy, experimental procedures, unproven procedures, alternative treatments, aversion therapy, blood pressure monitoring devices, dry needling, mind expansion psychotherapy, herbal drugs, massage, naturopathic care, paternity tests,  and retirement homes. This list is not all inclusive.

Does TRICARE Cover 100 Percent?

Nearly 10 million current and former military personnel are covered by TRICARE insurance. However, enlistment and accession dates impact the cost for care. Group A are those who enlisted before January 1, 2018, while Group B are those who enlisted on or after January 1, 2018.

Group A beneficiaries have lower enrollment fees and deductibles, but Group B beneficiaries typically have lower out-of-pocket (OOP) treatment costs.

This applies to TRICARE PRIME, TRICARE Prime Remote, TRICARE Select, TRICARE Young Adult (TYA) Prime, TYA Select, TRICARE Reserve Select (TRS), TRICARE Overseas Program (TOP) Select, TRICARE Retired Reserve (TRR), the US Family Health Plan (USFHP), and the Continued Health Care Benefit Program (CHCBP).

What Meds Does TRICARE Not Cover?

There are certain prescription medications that are not covered by TRICARE. Any drug that is listed in the non-covered category is excluded automatically. If a drug is designed to treat a condition that is not covered by TRICARE, then that drug is also excluded.

Drugs that are prescribed for cosmetic purposes are not covered. Multivitamins, homeopathic preparations, fluoride preparations, herbal preparations, multivitamins, and certain over-the-counter products are also excluded.

Although you can get prescriptions for these drugs yourself, you will have to shoulder the costs.

Is TRICARE Considered Good Insurance?

TRICARE serves as an excellent insurance for military personnel, including active duty service members and retired members. TRICARE covers a wide range of treatment programs for physical and mental health problems alike. It also provides some of the most affordable healthcare options in the country.

You can use TRICARE’s search feature to find out what is and what is not covered under your plan. You may find that plenty of primary, preventative, and hospital care services are covered. You can even use this search feature to find out which services are excluded.

What does TRICARE Cover and Not Cover?

TRICARE covers a lot of different services, including inpatient rehab for drug and alcohol addiction, outpatient rehab, and a lot of programs in between.

TRICARE insurance covers drug and alcohol rehab treatment. This means military members who are covered by TRICARE are eligible for a wide range of substance abuse treatment programs. Treatment centers like American Addiction Centers accept TRICARE.

Certain inpatient and outpatient programs are covered by TRICARE. Partial Hospitalization Programs (PHP) are covered, for example. For those who don’t require inpatient care, TRICARE also covers intensive outpatient programs and partial hospitalization programs.

Check your TRICARE insurance today to see what is and what is not covered by your plan. Taking care of your mental health is essential to ensuring a good quality of life moving forward.

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Fel Clinical Director of Content
Felisa Laboro has been working with addiction and substance abuse businesses since early 2014. She has authored and published over 1,000 articles in the space. As a result of her work, over 1,500 people have been able to find treatment. She is passionate about helping people break free from alcohol or drug addiction and living a healthy life.

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