Substance use disorder

Navigating Tricare Substance Abuse Coverage

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Substance abuse is a common issue among active soldiers and veterans. The stress and trauma that are part of military life can often cause personnel to turn to drugs or alcohol. Studies have shown that one in ten veterans are diagnosed with substance use disorder, a slightly higher proportion than the general population [1]. In an attempt to aid the recovery of military personnel and veterans, and help them and their families lead healthy, productive lives, the government established Tricare insurance. Tricare offers multi-tiered coverage for medical treatment for active military, veterans and their dependents. In this article, Avenues Recovery shares guidance on eligibility and treatment options covered by Tricare, including Tricare substance abuse coverage.

What Treatment Types Does Tricare Cover?

Included in the long list of Tricare-covered treatment are the following [2]:

  • Applied Behavior Analysis
  • Autism Spectrum Disorder
  • Cognitive Rehabilitation Therapy
  • Collateral Visits
  • Drug Testing
  • Eating Disorder Treatment
  • Electroconvulsive Therapy
  • Family Therapy
  • Gender Dysphoria
  • Intensive Outpatient Programs
  • Inpatient Hospital Services (emergency and non-emergency)
  • Management of Withdrawal Symptoms (Detoxification)
  • Medication Assisted Treatment
  • Office Based Opioid Treatment
  • Opioid Treatment Programs
  • Partial Hospitalization
  • Psychoanalysis
  • Psychological Testing
  • Psychotherapy
  • Psychotropic Drugs
  • Residential Treatment Facility Care
  • Substance Use Disorder Treatment
  • Therapeutic Services
  • Transcranial Magnetic Stimulation

Conditions such as PTSD, depression, and all forms of addictions are covered by Tricare plans as well. 

Locations for Tricare Insurance

Tricare is available across the globe [3]. Its management is split into three different regions.

Tricare West includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming.

Tricare healthcare plans in this region are administered by Health Net. This means that Health Net serves as the contractor to the government to provide access and benefits to the end users, in this case active military personnel, veterans, and their dependents. They provide networks, claims processing, and education.

Tricare East includes, Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.

The contracting partner for the eastern region is Humana Military.

Anywhere outside the United States is called the overseas region, and is managed by International SOS.

Tricare Plans and Eligibility

Tricare offers several different plans, each with unique eligibility, benefits and costs. A common question we get asked is “does Tricare cover therapy for dependants of military personnel?”, and the answer is yes. Returned soldiers often have emotional scars that affect those they live with, in many cases to the extent that family members of veterans require therapy themselves.

Tricare Prime

Who can enroll?

  • Active military personnel and family members
  • Retired military veterans and dependents (until eligibility for Medicare is reached)
  • Those who have received the Medal of Honor and families
  • Activated members of the National Guard, and in some cases Reserve and Retired personnel.
  • Former spouses who fill specific qualifications.

Any member of Prime on active duty as well as their families have zero out-of pocket costs. All others are subject to nominal enrollment fees and co-pays.

Tricare Select

Select is accessible in the U.S. and is a fee-for-service program. All above-mentioned members are eligible, excluding those on active duty. Out-of-pockets costs will include annual deductibles and some cost sharing. This varies according to each client’s military status.

Select can be a great option for those who have supplemental insurance to Tricare, like Medicare or commercial insurance from their workplace, or people who are happy with their current healthcare situation and don’t want to change to an in-network Tricare provider.

In order to confirm your eligibility and registration, connect with a preferred Tricare addiction treatment center. Because Avenues Recovery is one of the Tricare-approved rehab facilities, we are authorized to provide Tricare benefits and can get you properly set up right away. Our staff will navigate the Defense Enrollment Eligibility Reporting System (DEERS) [4], get you registered, and connect with your Primary Care Physician (PCPM) to arrange necessary referrals. All you have to do is give us a call, and we will take care of the rest!

Variations of these two main plans include:

  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Select Overseas
  • TRICARE For Life
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult

Call Avenues Recovery at 603-505-8365 to learn which plans work best for you.

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Tricare Substance Abuse Coverage

People receiving addiction treatment services from an approved provider such as Avenues Recovery  can often receive Tricare substance abuse coverage. Medications and care for detox and residential treatment are all part of Tricare benefits. Furthermore, once a member is enrolled in Tricare-approved drug rehab programs like inpatient rehab and Partial Hospitalization Programs, detox services may be included as well.

Does Tricare Cover Inpatient Rehab?

Yes! As long as you have been diagnosed with substance use disorder (SUD), are dealing with withdrawal symptoms requiring medical attention, and are having difficulties coping with daily routines, residential treatment is absolutely necessary and covered by your Tricare plans. This falls under emergency treatment.

In the event of non-emergency addiction treatment, such as when a person feels the need for treatment on his own, he must be authorized by Tricare or its managing partner. Avenues can help facilitate those authorizations upon contact from the client seeking addiction treatment.

Does Tricare Cover Outpatient Programs?

When qualifying, Tricare will give coverage for many types of outpatient programs. Intensive Outpatient Programs (IOP) and PHP are often eligible. There are many individuals who while not needing round the clock medical care and supervision, greatly benefit from treatment groups and counseling sessions offered by Tricare preferred providers. The flexibility of such treatment gives clients the chance to resume their daily routines, family responsibility and jobs while remaining under the care of addiction treatment facilities. In some cases, Medication-assisted treatment (MAT) is necessary and covered as well.

Can Veterans Affairs Beneficiaries Access Tricare?

The Department of Veterans Affairs is a cabinet-level agency tasked with providing benefits and and support for military veterans in their time after service. The VA provides health care through its medical facilities and clinics across the country. Since 1995, every Veterans Affairs’ health care facility has been part of the Tricare network [5]. This means that they are able to service all Tricare members, including Active Duty personnel, retirees and their families on a space available basis. This is true for both primary and specialty care.

Tricare Addiction Treatment at Avenues Recovery

At Avenues Recovery, the gratitude we feel towards military personnel who have sacrificed greatly to protect us is endless. We will leave no stone unturned to place the chance for a normal, productive life within your reach without any financial hardship. So many mental health and addiction treatment options are available with your Tricare coverage. Our skilled staff will explain them all, facilitate the insurance coverage that is needed, and hold your hand through the entire drug and alcohol rehab process.

You deserve a second chance. Let us help you find the path to recovery! Contact us today to begin the process. 

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