Addiction may not be readily seen. There may be suspicions. There may be warning signs. There may be genuine concern. Addiction can lay in the shadows for years. And, until it is brought to the light, it continues its devastating course.

According to substance abuse professionals, addiction is a brain disease that does not get better without treatment. It is a disease that is chronic and progressive, meaning that it does not get better “with time.”

It only gets better with proper medical attention and therapeutic interventions. When you or loved one is in need of drug or alcohol treatment, so many worries can rise to the surface: Does Tricare help with drug and alcohol treatment? How much will this cost me? Will Tricare cover treatment interventions for my child?

Here, we will examine:

  • Government data on the prevalence of addiction in the U.S.
  • Tricare drug rehab coverage for adults struggling with addiction.
  • Tricare coverage for children with drug and/or alcohol issues.
  • The need for prior authorization to ensure Tri-care drug rehab insurance coverage.
  • Possible out-of-pocket expenses.
  • Where you can find help in understanding and choosing the treatment that’s right for you.

Addiction in the U.S.

According to data collected by the Center for Disease Control (CDC), starting at about 12 years of age, an incredible 10% of teens reported using illegal substances in the past month. SAMHSA, the government organization that monitors substance abuse trends in the U.S., reports that:

  • More than 20 million persons have been diagnosed, or can be diagnosed with a chemical dependency illness
  • This translates to about 1 in 12 persons in the U.S.
  • 7.7 million people have a mental health diagnosis accompanying substance abuse

Gleaning from these data, you are quite likely to face a situation ravaged by addiction at some point in your life. An empowering initial step is knowing what your insurance plan covers in regards to addiction treatment.

Tricare Insurance for Rehab for Adults

If you have been diagnosed with an opioid use disorder, Tricare helps with medication-assisted treatment from an authorized physician, uniting drug and mental health interventions. This doctor has to have a specific certification from the Drug Enforcement Administration (DEA) to administer buprenorphine, or suboxone.

Tricare typically covers the following:

  • short- or longterm residential inpatient services
  • outpatient programs
  • individual, group, family/spousal sessions
  • psychoanalysis, if the intervention is pre-authorized and the psychoanalyst has achieved psychoanalytic training from an organization approved by the American Psychoanalytic Association
  • psychological assessments to evaluate needs in treatment and create a treatment plan
  • electroconvulsive therapy (ECT) for rare and specific interventions for mental illness
  • select psychotropic medications when approved in the treatment plan
  • medication-assisted interventions
  • all collateral visits with the psychiatrist and anyone involved in the treatment plan

Additional interventions that Tricare often covers include:

  • art
  • dance
  • music
  • occupational

Tricare coverage does not include:

  • aversion therapy techniques
  • sober living homes, halfway houses, etc.

For Tricare to pay for authorized partial hospitalization, the patient must:

  • have a diagnosable psychiatric or chemical dependency issue
  • be able to operate, with support, in a few major areas of life
  • not be in need of full-time medical attention

Tricare may extend coverage for partial hospitalization services for the patient who:

  • requires medically supervised detox with continuous availability to medical interventions
  • requires some medical assistance but not around the clock
  • has a substantial impairment that hinders average functioning
  • benefits from stabilization, displaying intense symptoms
  • requires treatment for partly controlled mental health issues, or is stepping down from a residential facility
  • has an inability to sustain him/herself within society with only outpatient support

Tricare will cover in-network inpatient facilities, including detoxification and rehabilitation, when the patient is having substantial difficulties functioning in numerous major life areas or if he/she is diagnosed with a chemical dependency disorder and exhibits withdrawal issues that are:

  • serious enough to demand inpatient attention and psychiatric monitoring
  • less serious, but demand close 24-hour assessment

Tricare Rehab Coverage for Children

Coverage for children with chemical dependency issues is very similar to adults. When the interventions and level of care are deemed “medically necessary,” Tricare usually covers:

  • inpatient services
  • outpatient programs
  • individual and group counseling
  • family addiction education and intervention
  • psychoanalysis
  • psychological assessments
  • electroconvulsive therapy (ECT)
  • select psychotropic medications when approved in the treatment plan
  • withdrawal and craving interventions
  • collateral visits with anyone involved in the treatment plan

Prior Authorization

When an insurance company requires “prior authorization,” this can apply to any service offered for substance abuse treatment. To gain prior authorization, a patient must be evaluated by a medical professional, and the interventions must be ruled as “medically necessary.” To find out which services require prior authorization, ask your insurance provider.

Out-of-pocket Addiction Treatment Expenses

These expenses pertain to how much you’ll owe in addition to what your insurance plan covers. Oftentimes, these costs include:

  • deductibles
  • co-payments
  • additional charges

These amounts can vary greatly depending on which insurance plan you hold. You’ll need to know which fees come with your particular plan.

Help Finding a Drug Rehab that Accepts Tri-Care Insurance

We at understand that the huge number of choices for treatment can feel staggering. This is why we provide a free, 24/7 national helpline to help you feel informed and supported as you choose which treatment is right for you. Our licensed counselors are here to answer questions and concerns, and offer confidential referrals to some of the best facilities in the country covered by your insurance. Give us a ring and give us a chance to make the next step easier for you!