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TRICARE Insurance Coverage for Drug and Alcohol Rehab

July 27, 2020 , Agape Treatment Center

man smiling outside of a TRICARE insured rehab program in FloridaTRICARE health insurance is a healthcare insurance program that offers substance abuse treatment coverage for military service members and their families. If you are an active-duty service member, a veteran, or a family member, it is likely that you can use TRICARE insurance to help cover the cost of drug and alcohol rehabilitation services.

TRICARE Addiction Treatment Services

According to statistics revealed by the Substance Abuse and Mental Health Services Administration (SAMHSA), 1.9 million Americans sought treatment for substance abuse in 2017. Major changes in its coverage options in 2017, TRICARE expanded its list of addiction treatment services.

Similar to all insurance plans, different levels of coverage vary based on eligibility restrictions, specific plan details, and other factors. Here are some of the most common available TRICARE coverage options for drug and alcohol rehab programs in Fort Lauderdale, Florida.

TRICARE Healthcare Plans

TRICARE health insurance is similar to other medical insurance plans in regard to the various options available to individual policyholders. All of the available TRICARE plans either meet or exceed the standards established by the Affordable Care Act in order to ensure that individuals have the quality health insurance options to meet their specific needs.

Each individual TRICARE plan has a comprehensive list of what it does and does not cover. However, there are 8 different TRICARE programs available to clients:

  • TRICARE Prime – provides coverage in a specific geographical area that has been predetermined to be a “prime” location in the U.S.
  • TRICARE Prime Remote – a plan that provides coverage in more remote locations within the U.S., as well as overseas.
  • TRICARE Standard and Extra – This plan requires a paid fee but does not require enrollment for members to receive services.
  • TRICARE Standard Overseas – a plan that provides comprehensive coverage for policyholders that are overseas.
  • TRICARE for Life – a Medicare coverage option that provides additional help for people who have Medicare Part A and B.
  • TRICARE Reserve Select – this is a premium-based plan that provides coverage for qualified reserve service members and their families.
  • TRICARE Retired Reserve – a premium-based plan that provides coverage for retired service members and other veterans (under the age of 60) and their families.
  • TRICARE Young Adult – this plan provides coverage for young adult children who do not qualify for other TRICARE coverage options.

Does TRICARE Cover Drug and Alcohol Detox?

Individuals seeking addiction recovery services from professional rehabilitation centers may have drug and alcohol detoxification services covered by their individual TRICARE plan. Medical care and medications received while at an approved drug and alcohol detox programs fall under the detox category if the services are provided to control withdrawal symptoms.

Furthermore, substance abuse detoxification services are covered once a TRICARE policyholder is enrolled in the approved inpatient or outpatient care program. Residential and partial hospitalization facilities also qualify as medical settings authorized to bill for detoxification services under TRICARE coverage.

Will TRICARE Insurance Cover Inpatient Rehab?

TRICARE plans generally offer coverage for both urgent and non-emergency inpatient addiction treatment services, as long as all conditions have been met. In other words, the client must:

  • Have a formal substance use disorder diagnosis
  • Experience withdrawal symptoms severe enough to require physical assistance or supervision.
  • Struggle with the normal functions of everyday life

If these requirements are met, TRICARE will offer coverage for both emergency and non-emergency inpatient drug and alcohol rehabilitation services. Emergency treatment is considered to be a necessity when an individual is experiencing a medical or psychiatric crisis and requires immediate medical assistance. Non-emergency treatment is when an individual decides to seek treatment for addiction on his or her own.

In order for non-emergency treatment to be covered, TRICARE must authorize the services and service provider prior to coverage being provided. In order to understand whether or not your TRICARE insurance plan will cover inpatient drug and alcohol rehab, contact your service provider for specific details on your individual plan.

TRICARE Coverage for Outpatient Treatment

TRICARE also provides coverage for outpatient drug and alcohol rehab if an individual’s plan meets the specific qualification requirements. In order for coverage to be provided for outpatient addiction treatment, an individual must be active in addiction but not in need of hospitalization or around-the-clock care. TRICARE covers several types of outpatient treatment services such as:

  • Standard outpatient programs
  • Intensive outpatient programs (IOP)
  • Partial hospitalization programs (PHP)

These specific outpatient drug and alcohol treatment programs offer the same therapeutic resources as inpatient rehabs such as group therapy and individualized counseling. Rather than providing these services all day every day, outpatient treatment administers these therapies through multiple weekly treatment sessions so that patients are able to maintain their careers and families throughout the treatment process.

Will TRICARE Cover Medication-Assisted Treatment?

TRICARE clients who are diagnosed with an opioid use disorder may qualify for medication-assisted treatment coverage. This specific type of treatment includes mental health therapies as well as medication maintenance to prevent withdrawal and encourage long-term sobriety.

Patients may not be required to seek prior authorization for medication-assisted treatment when acquiring care from a TRICARE-authorized drug and alcohol rehabilitation facility. In order to qualify, the drug and alcohol rehab facility must have authorization from the Drug Enforcement Agency (DEA) to prescribe and monitor the use of medications such as Suboxone or Methadone.

How Can I Confirm my TRICARE Benefits for Agape Treatment Centers?

Knowing what services your TRICARE plan will or will not cover is an important aspect of figuring out the drug and alcohol treatment program that is right for you. In order to confirm your TRICARE benefits, call your service provider, get accurate information about the type, level, and amount of drug treatment that your policy covers.

Here at Agape Treatment Center, we value all of our active duty service members, veterans, and their family members. Our goal is to ensure that every client receives professional drug and alcohol treatment services that address not only addiction but any co-occurring disorders such as PTSD, anxiety, and depression as well.

Our compassionate team in Fort Lauderdale will help guide you through the admissions process by checking your individual TRICARE coverage options. If you or someone you love is struggling with addiction and seeking help – call us today!