Does Tricare Cover Heroin Rehab?

Written by: Editorial Staff

Last updated on March 17, 2021

For those seeking recovery from heroin addiction for themselves or a loved one, TRICARE health coverage provides coverage for rehabilitation treatment. TRICARE is the healthcare program for uniformed service members, veterans, and their families. From medical detox to inpatient therapy to continued treatment, TRICARE plans make most types of addiction recovery treatment affordable and accessible for those who need it.

As with all insurance plans, the level of coverage depends on eligibility restrictions and policies. It is important to explore your TRICARE plan’s available coverage for heroin addiction treatment to take the first step toward recovery.

If TRICARE is your healthcare insurance provider, your policy likely covers some of the costs of drug and alcohol rehabilitation. Call the number on the back of your insurance card for more information about your specific plan. Alternatively, most rehab facilities can check your coverage based on the information you provide them.

Tricare Insurance Heroin Treatment Coverage

In 2017, TRICARE updated its benefits to include mental health coverage for drug and alcohol addiction treatment, including treatment for heroin addiction. A variety of levels of care may be covered by your TRICARE plan, with services including:¹

• Inpatient services (emergency and non-emergency)
• Intensive outpatient programs
• Management of withdrawal symptoms (detoxification)
• Medication-assisted treatment
• Mental health therapeutic services
• Office-based opioid treatment
• Opioid treatment programs
• Partial hospitalization programs
• Residential substance use disorder treatment

Some of the more commonly used rehab services for heroin addiction covered by TRICARE include:

Medical detox: Medication-assisted treatment is often deemed medically necessary for those who are addicted to drugs that create intense withdrawal symptoms. Abstaining from some drugs like heroin requires a complex withdrawal process that is best completed under medical supervision. Medical detox takes place before any inpatient or outpatient treatment. TRICARE health plans cover medical detox for those who have an opioid addiction and require medical support as a result.

Inpatient treatment: Inpatient rehab involves living in a treatment facility from 30-90 days to help a person get and stay sober. Patients attend counseling sessions, both solo and in group therapy, to help identify reasons for addiction and learn healthy coping mechanisms to live a full, sober life. TRICARE covers the cost of inpatient residential treatment if conditions are met: the person must have a substance use disorder diagnosis from a physician, their withdrawal symptoms require medical assistance, and they are struggling to function in day-to-day life. TRICARE covers both emergency and non-emergency inpatient addiction treatment for those who enter rehab. The amount of coverage depends on the type of plan you have. Preauthorization may be required from TRICARE.

Outpatient treatment: Outpatient rehab programs are for people who are struggling with substance abuse disorder, including heroin addiction, but do not need to be in a hospital or residential facility full-time. This type of treatment is often well-suited for people who have completed inpatient treatment and need ongoing care to prevent relapse. Prior authorization may not be needed for TRICARE to cover the costs. Your plan will outline the qualifications required for you to receive coverage. For example, your policy may cover a partial hospitalization program, intensive outpatient program, or a standard outpatient program.

Knowing what your TRICARE plan covers can help you avoid unexpected costs while you or your loved one are receiving treatment, giving you peace of mind over financial worries on your path to sobriety. For more information on your plan, you can call the number on the back of your insurance card or call us at 1-888-496-8059 Who Answers? and we can find out what is covered for you.

Is Mental Health Covered by Tricare Insurance?

Many people who have substance use disorders also have mental health disorders such as anxiety, depression, mood disorders, and PTSD. According to the U.S. Department of Veteran Affairs, approximately 20% of veterans with PTSD also live with substance use disorder.² People with both a substance use disorder and another mental health condition are said to have co-occurring disorders, or a dual diagnosis.

For recovery to be successful, it is essential to treat co-occurring mental health and substance use disorders at the same time, as they can impact and exacerbate each other. Treating one will not be a “fix” for the other.

TRICARE covers a variety of services for mental health and substance use disorders, including:

• Ancillary visits (e.g., inpatient facility, residential substance use disorder treatment).
• Collateral visits (e.g., visits between a provider and family members/caregivers of the person living with addiction).
• Psychotherapy.
• Psychoanalysis.
• Psychological testing and assessment.

TRICARE does not cover aversion therapy or treatments that are not yet scientifically proven to be effective.

TRICARE plans

TRICARE offers several different health plans for active-duty service members and veterans. These vary depending on your status in the military, your age, and where you live. The following plans are currently available:³

• TRICARE Prime: for active-duty service members.
• TRICARE Prime Remote (TPR): a managed care option available in remote areas in the United States. You can use TPR if your sponsor’s home and work addresses are more than 50 miles (or a 1-hour drive time) from a military hospital or clinic.
• TRICARE Prime Overseas: for active-duty members and their families. This option provides managed care in overseas areas near military hospitals and clinics.
• TRICARE Prime Remote Overseas: For active-duty members and their families in designated remote overseas locations.
• TRICARE Select: A self-managed, preferred provider network plan for active service members.
• TRICARE Select Overseas: A managed care option for service members and veterans in designated remote overseas locations.
• TRICARE For Life: Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B.
• TRICARE Reserve Select: For members of the Selected Reserve (and their families) who are not active duty.
• TRICARE Retired Reserve: For retired service members under the age of 60 and their families.
• TRICARE Young Adult: A plan that qualified adult children of service members can purchase after their eligibility for regular TRICARE coverage ends at age 21 (or 23 if enrolled in college).
• US Family Health Plan: For active-duty and retired service members and their families.

Tricare Covered Rehab

The amount of coverage you have for heroin addiction treatment services depends partly on whether you choose an in-network or out-of-network provider. Some TRICARE plans require you to use an in-network provider. Others will allow you to choose the rehab center you desire, whether it is in- or out-of-network.

TRICARE plans cover treatments and procedures that are proven to be medically necessary. Because of this, patients are most often required to select rehab centers that are approved by or have a partnership with TRICARE. Participating in-network rehab centers have a pricing agreement with TRICARE for billing addiction treatment services.

If you choose an in-network addiction rehab center, you will be responsible for only a portion of the cost, based on the plan you have and the facility you have chosen.

For those enrolled in TRICARE Select, Reserve Select, Retired Reserve, Young Adult Select, and Prime Remote plans, you may have the option to choose an out-of-network rehab center of your choice. However, you may have to file your claims directly for reimbursement, and you may pay a higher percentage of the cost of treatment.

American Addiction Center’s Desert Hope location in Las Vegas offers a special program focused on veterans and their particular needs. The Salute to Recovery program was created with the unique challenges of veterans in mind. It is dedicated to helping military veterans develop solid strategies for promoting positive decision-making and making permanent healthy lifestyle changes.

Rehab Not Covered by TRICARE

Depending on the rehab facility you choose, you might have to pay a partial or full treatment cost. If TRICARE does not cover the full cost of your rehab, other methods of payment may be available.

Some rehab centers offer payment plans, financing, and scholarships to qualifying people. Don’t let finances stand in the way of your sobriety. Getting treatment now is critical to your safety—and in some cases, is a matter of life and death.

How to Find TRICARE Covered Rehab?

In most cases, TRICARE will cover some or all of your heroin addiction treatment, whether you are on active duty, a veteran, or a family member of a service member. Check your TRICARE plan benefits to determine what costs will be covered and which may be out-of-pocket for you. Call the number on the back of your insurance card to learn more about your specific plan.

American Addiction Centers can also verify your insurance coverage for you. Complete the form below to enter your information and to see if the facility you are considering is in-network with TRICARE. You can also call our helpline at 1-888-496-8059 Who Answers? to speak to a person who can check your benefits for you while you’re on the phone.

Sources

[1] Tricare. Substance Use Disorder Treatment.

[2] U.S. Department of Veterans Affairs. (2015). PTSD and substance abuse in veterans.

[3] Tricare. Health Plans.