tricare insurance coverage for rehab

Before undergoing treatment, it’s natural to have concerns about insurance coverage. Going through insurance can seem like a tricky task to navigate. However, we assure you that Tricare insurance can help you receive the help that you deserve.

Our addiction counselors will also be able to help you understand your Tricare insurance benefits. We’ll speak to your provider and give you the rundown on what your insurance covers. 

What Insurance Terms are Useful to Know?

It’s helpful to understand some insurance vocabulary as you start the treatment process. Although we’ll take care of the insurance evaluation for you, it can still be useful to understand these terms. See below for the following Tricare insurance terms:

Premium

An insurance plan premium is a payment you make to your provider that keeps your plan active. 

Out-of-Pocket Maximum

This is the most that you’ll have to pay for covered services within a plan year. After these costs are taken care of through deductibles, copayments, and coinsurance, your insurance provider will cover the remaining costs.

Policy Effective Date

This is when your policy begins. In other words, this is when it will be deemed as effective. You’ll get access to your benefits, which vary depending on your plan. 

Deductible

A deductible is an amount that must be paid for covered medical services before your provider begins paying.

Copayment

A copayment, or copay, is a cost you may pay before you receive a medical service. For instance, let’s say you need to pay $2,000 for inpatient treatment at a treatment center. Your health insurance plan may pay half of that price, and then require a $500 copayment to cover the rest. 

Does Tricare Insurance Cover Mental Health Treatment?

Tricare insurance covers mental health treatment. When treating addiction, it’s crucial to take into account the underlying roots of addiction. It is much more than a physical disease. Addiction affects an individual’s emotional and mental state as well.

Fortunately, with Tricare insurance, you’ll be able to reap the benefits of mental health treatment at our recovery center. We offer many evidence-based forms of therapy, such as cognitive behavioral therapy and group therapy. 

Therapy will help you develop a toolkit of skills that will help you cope with stress and cravings. Each recovering individual will receive a unique combination of services that best suits their recovery needs. 

What are Co-Occurring Disorders?

Co-occurring disorders are when an individual has an addiction, as well as a mental illness. These are treated at our recovery center. If you require treatment for a mental health disorder and addiction, then you’ll require dual diagnosis treatment. 

Dual diagnosis treatment targets co-occurring disorders through different methods. We treat disorders such as:

  • Anxiety
  • Depression
  • Eating disorders
  • Bipolar disorder
  • Post-traumatic stress disorder

How Do We Determine Your Benefits?

When we go through Tricare insurance, we’ll be able to let you know exactly what your plan offers. Our goal is to provide you the highest quality of treatment at the most effective cost. Our dedicated addiction treatment staff will constant your Tricare insurance provider and go through your plan. 

We go through a simple two-step process. The steps are as follows:

Step 1: Confirming Your Tricare Insurance Benefits 

We’ll start with a complimentary and thorough evaluation of your insurance benefits. This takes a lot of stress off of your hands! We’ll reach out to your provider and determine what kind of benefits are covered under your specific plan.

Step 2: Verifying Addiction and Dual-Diagnosis Benefits of Your Tricare Insurance Plan

After the in-depth evaluation, we’ll let you know:

  • How much of the expenses your insurance company will cover
  • What level of care you’ll be covered for
  • The length of time you’ll be covered for inpatient care (30, 60, 90 days, etc.)
  • How much you can expect to pay out-of-pocket for a treatment program

Tricare Prime Plan

Tricare Prime is a managed care option available in “Prime Service Areas,” such as the East Coast. This plan ensures medical readiness of active duty by adding to the capability and capacity of military hospitals and clinics. Prime Service Areas were also built around the Base Realignment and Closure sites.

Additional Prime options for active duty service members and their families include:

  • Tricare Prime Remote
  • Tricare Prime Overseas
  • Tricare Prime Remote Overseas 

Who Can Enroll in Tricare Insurance Prime?

  • Active duty service members and their families
  • Retired service members and their families*
  • Activated
  • Called or ordered to active duty service for more than 30 days in a row
  • Guard/Reserve members and their families
  • Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
  • Retired Guard/Reserve members at age 60 and their families*
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

*When retired service members and their families become eligible for Medicare based on age, they aren’t able to participate in Tricare Prime.

How Does Tricare Insurance Work?

You have an assigned primary care manager (PCM) who will help guide you through coverage. Your primary care manager will help:

  • Refer you to specialists for the care he or she can’t provide
  • Work with your regional contractor for referrals/authorization
  • Accept your copayment
  • Files claims for you

What You Pay

Active duty service members pay nothing out-of-pocket. Active duty family members also pay nothing out-of-pocket unless using the point-of-service option. 

All other members pay annual enrollment fees and network copayments.

How do I Enroll in Tricare Prime?

  1. Online via the Beneficiary Web Enrollment website
  2. Call your regional contractor

East Region: Under the new regional contracts, the East Region is a merger of the North and South Regions and 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. Tel: (800) 444-5445

West Region: 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. Tel: (844) 866-9378

  1. Mail the enrollment form to your regional contractor (mailing addresses on the form):
  • East Region Form
  • West Region Form

Tricare Select Plan

Tricare Select is a fee-for-service plan available in the U.S. You must show eligibility for Tricare in the Defense Enrollment Eligibility Reporting System (DEERS). You need to register in DEERS in order to get Tricare insurance under the Select Plan.

Who Can Participate?

  • Active duty family members
  • Retired service members and their families
  • Family members of activated
  • Called or ordered to active duty service for more than 30 days in a row.
  • Guard/Reserve members 
  • Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
  • Retired Guard/Reserve members at age 60 and their families
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

How it Works

The first step is an appointment with any Tricare-authorized provider. An authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by a national organization, or meets other standards of the medical community and is certified to provide benefits under Tricare insurance. This includes us!

There are two types of Tricare-authorized providers: Network and Non-Network. Referrals are not required, but you may need prior authorization from your regional contractor for certain services.

What You Pay

Costs will be dependent upon the sponsor’s military status. You will have to take care of:

  • An annual outpatient deductible
  • Cost shares (or percentage) for covered services

Is Tricare Select Right for You?

If you’re on active duty (including activated Guard/Reserve members), you are not eligible for Tricare Select. 

Tricare Select may be a great fit for you if:

  • You live in an area where you can’t use Tricare Prime
  • You have other insurance providers
  • Health insurance you have in addition to Tricare, such as Medicare or employer-sponsored health insurance. 
  • You’re seeing a provider who isn’t in the Tricare network and you don’t want to switch.

Covered Treatments under Tricare Insurance

Tricare insurance covers medically and psychologically necessary mental health and addiction care. This includes both inpatient and outpatient rehabilitation treatment. 

Tricare insurance can also help you cover treatments such as:

  • 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

Tricare Insurance Coverage for Inpatient Rehabilitation Treatment

Tricare covers residential treatment if several conditions are met, including that:

  • The patient has a formal substance use disorder diagnosis
  • He has withdrawal symptoms severe enough to require medical care
  • She struggles to function in everyday life

If these requirements are met, Tricare will cover both emergency and non-emergency residential treatment.

Tricare insurance takes care of detoxification, stabilization, and any medical complication costs when it comes to emergency treatment.

Non-emergency treatment is when an individual decides to look for addiction treatment on his or her own. This will require prior authorization from Tricare before coverage will be provided. Tricare insurance generally covers detox and stabilization, as well as treatment for any additional co-occurring disorders.

Tricare Insurance Coverage for Outpatient Treatment

They will also cover outpatient treatment if an individual’s plan meets certain qualifications. An individual that is currently struggling with addiction, but not in need of hospitalization or around-the-clock care is the ideal candidate. 

Tricare insurance coverage takes care of all the different types of outpatient programs. Standard outpatient treatment is the least intensive form of care. Other programs, such as intensive outpatient care, consist of scheduled treatment sessions several days per week. 

A partial hospitalization program offers the most intensive outpatient program and requires daily treatment that lasts about four to eight hours.

Seek Help with Harmony Ridge Today!

Don’t delay getting treatment any longer because you worry about paying for it. Find out how affordable treatment can be with Tricare insurance.

At Harmony Ridge, we believe in providing the highest quality of treatment at affordable costs. We’ll help you show you the potential you’ve always had. Addiction doesn’t have to control your life anymore. With the right treatment and support, your life can drastically change for the better. 

We’re here to help you not just through insurance coverage and benefits, but everything else you may need as well. If you have any questions, comments, or concerns, please don’t hesitate to reach out to us. We’re ready to take your call!