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Many American veterans turn to drugs and alcohol to numb the physical and psychological pain from the challenges they faced in the service. Consequently, this led to substance use disorder (SUD) now affecting over 1 million veterans. For that reason, many veterans require TRICARE insurance as a safety net for their health care needs, addressing physical and mental health issues such as SUD. 

TRICARE represents a tangible expression of the nation’s gratitude for veterans’ service, helping them transition into civilian life with the support and care they deserve. Furthermore, TRICARE offers veterans peace of mind, knowing they can receive necessary medical treatment without the burden of exorbitant healthcare costs.

What is TRICARE?

TRICARE is managed by the Pentagon’s Defense Health Agency, making it the U.S. Armed Forces healthcare program providing rehab services for veterans. Even though TRICARE offers its own healthcare providers and facilities, delivered in military medical facilities like VA hospitals, it functions as government-managed, single-payer health insurance.

The exceptions are active-duty service members, who pay zero out-of-pocket healthcare costs. Several plan options serve TRICARE enrollees and beneficiaries. However, these options depend on their military status and state of residence.

TRICARE’s enrollment-based health plans include: 

  • TRICARE Prime: Like a health maintenance organization (HMO), TRICARE Prime assigns members a primary care manager who makes referrals to specialty caregivers when needed. TRICARE members’ out-of-pocket costs depend on their military service status.
  • TRICARE Select: TRICARE Select resembles a preferred provider organization (PPO). Enrollees in TRICARE Select can choose their primary care manager and refer them to the specialist caregiver of their choice. However, some medical services come with out-of-pocket costs, though how much a TRICARE member must pay depends on military service status.
  • TRICARE Reserve Select: TRICARE Reserve Select is a plan for traditional National Guard members and those in the National Reserve. TRICARE Reserve Select operates like TRICARE Select, except enrollees pay a monthly premium.
  • TRICARE Young Adult: TRICARE Young Adult is an option for unmarried adult children. The plan provides both medical and pharmacy benefits.

Deductibles and Other Cost Concerns

Active-duty service members—required to enroll in TRICARE Prime—are the only beneficiaries who never have to pay deductibles or out-of-pocket (OOP) costs for services and prescriptions covered by their TRICARE plans. Other TRICARE Prime and Select plan users usually must pay deductibles and additional costs.

Depending on someone’s beneficiary status and the specific Prime or Select plan they chose, they may have to pay one or more of the following:

  • Annual deductibles
  • Cost-shares
  • Enrollment
  • Annual deductibles
  • Copayments
  • Enrollment fees or premiums

TRICARE offers a Compare Cost Tool for those needing details regarding TRICARE-covered rehab for veterans. 

Does TRICARE Cover Rehab for Veterans?

TRICARE covers alcohol and drug rehab and other treatment plans for veterans under specific plans. The insurance is widely accepted at addiction treatment centers across the country. However, some variables are to be considered, such as what is covered under each person’s unique health plan.

All TRICARE-eligible beneficiaries have access to mental health and substance use disorder benefits. However, how one receives that care may depend on their plan’s particulars. For instance, some TRICARE enrollees may have to get a referral for certain office-based outpatient services. Meanwhile, active-duty service members should seek nonemergency mental health care at military facilities whenever possible.

Practically all TRICARE plans partially or fully cover veterans medical treatments for substance abuse, including:

  • Alcohol
  • Cocaine
  • Prescription painkillers like Oxycontin and Percocet
  • Heroin and fentanyl
  • Benzodiazepines like Valium and Xanax
  • Stimulants like Adderall and Methamphetamine
  • Marijuana  

Most TRICARE plans provide comprehensive treatment for substance use disorders, including detox, emergency, and inpatient hospital services. However, TRICARE reimburses only the cost of care if the enrollee goes to a TRICARE-authorized provider.

TRICARE covers many addiction treatment programs, such as rehab for veterans, when recommended by a qualified mental health professional who believes it is medically necessary for the patient. From there, an individually tailored medical detox and therapy program integrated with psychosocial and medical treatment and support transpires.

The addiction treatment programs TRICARE covers include:

  • Medically-supervised detox
  • Residential addiction treatment
  • Inpatient services (emergency and non-emergency; this includes detox)
  • Intensive outpatient programs (IOP)
  • Partial Hospitalization Program (PHP)
  • Opioid treatment programs (OTP) 

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a therapeutic approach to addiction treatment that combines prescription medication and mental health therapies. MAT treats a substance use disorder and removes some of the severity of drug or alcohol withdrawal symptoms. TRICARE-authorized healthcare providers may administer MAT services. However, they must have a special Drug Enforcement Agency (DEA) certification to prescribe buprenorphine.

Does TRICARE Cover Mental Health Treatment?

TRICARE covers mental health and substance use disorder treatment, including inpatient and outpatient treatments. Also, TRICARE covers office-based psychotherapy when deemed medically or psychologically necessary for any combination of individual, family, or group sessions for a diagnosed and covered condition from an authorized provider. However, the health plan does not cover certain mental health services, such as aversion therapy, marriage counseling, and experimental or unproven procedures.

The Veterans Compact Act of 2020

Veterans do not have to seek treatment at a VA facility. Instead, TRICARE allows them to seek treatment at private addiction treatment centers. TRICARE coverage covers the cost of detox, medication-assisted treatment (MAT), inpatient residential, PHP, and IOP treatment programs. 

Also, if the veteran is suicidal, their treatment is free, with zero out-of-pocket costs. This coverage took effect in January 2023 as part of the Veterans COMPACT Act of 2020. All veterans qualify for this benefit, whether enrolled in TRICARE or not. However, they must enroll in a treatment program and report if they are suicidal.

Find TRICARE Covered Rehab in Nashville, TN

Understandably, veterans often find it challenging to seek addiction help while adjusting to civilian life. Some veterans may hesitate to seek help due to the negative stigma of SUD in the military. We understand that insurance is confusing. That’s why our experienced counselors are here to answer questions about TRICARE rehab for veterans and whether it will reduce or cover your costs. 

Every veteran deserves to live a life free of addiction. Freeman Health Partners is here to help you get past the negativity and back to a healthy, happy life of sobriety.

Reach out to our consultants today.