Tricare Insurance was previously known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). It is the health care program of the United States Department of Defense Military Health System. Although it is the civilian care of the Military Health System, it has also historically included care provided in military medical treatment facilities.
Who is Eligible?
Tricare provides civilian health benefits for:
- Active duty U.S. military personnel
- Military retirees
- Spouses or children of active duty or retired uniformed service members
- National Guard or Reserve members
- Spouses or children of National Guard or Reserve members
- Survivors of deceased military members
- Medal of Honor recipients
- Spouse or children of Medal of Honor recipients
- People that are registered in the Defense Enrollment Eligibility Reporting System (DEERS)
Not all members of the armed forces are eligible for Tricare health benefits. Armed forces members are urged to check their DEERS eligibility to make sure that they are.
Department of Defense Management
The Defense Health Agency (DHA) manages Tricare. But before October 1, 2013, the Tricare Management Activity (TMA), which was dissolved, managed Tricare. Management was then transferred to the new DHA.
This means that the Department of Defense operates a health care system that served about 9.4 billion beneficiaries in 2018. This represents $50.6 billion or 8% of total U.S. military spending for 2019.
Even though the organization ultimately responsible for the administration of Tricare is the U.S. Department of Defense Military Health System (who organized the TMA), the TMA contracts with several large health insurance corporations to provide customer service, claims processing, and other administrative functions to the Tricare program.
What Does Tricare Cover?
Tricare provides health insurance coverage that varies by:
- Who enrolls
- What plan members use
- The needs of members
Each of these factors can affect what health cares and what the out-of-pocket expenses may be. Below is a general list of Tricare benefits.
This is basic health care. The goal of preventative care is to ensure wellness while preventing worse problems. Preventative care also helps identify possible future health issues.
This includes treatment to improve mental health through:
- Individual and family therapy
- Substance abuse treatment
- Treatment for eating disorders
- Psychological testing
- Behavior analysis
Coverage for eye examinations and needed correctives in the form of glasses or contacts.
Pharmacy benefits provide access to filling and receiving prescription medications.
Dental care provides coverage for dental cleanings and procedures. This form of care is separate from the healthcare program and thus, needs separate enrollment.
Tricare offers programs for other medical needs such as:
- cancer clinical trials
- hospice care
- durable medical equipment
What Addiction Treatment Programs Does Tricare Cover?
Tricare offers substance use disorder (SUD) treatment as part of its mental health coverage. Below are the covered treatment services of Tricare insurance.
Inpatient Treatment (emergency and non-emergency)
Tricare covers emergency inpatient hospital services when individuals suffer from a medical or psychiatric emergency and need to be admitted into a hospital immediately. Emergency inpatient treatments can receive care at the nearest available hospital.
If you suffer from a mental health disorder or a SUD, Tricare covers emergency inpatient services for:
- Any complications from the disorder
Intensive Outpatient Programs (IOP)
You can qualify for an IOP if you:
- Suffer from a mental health or substance use disorder
- Don’t require full-time hospitalization
- Need stabilization or reduction of addiction symptoms, or relapse prevention
- Desire treatment for mental health disorders that are only partially stabilized
- Need a higher level of care than outpatient care
- Are transitioning from an inpatient program into a psychiatric residential treatment program
- Suffer from a partial hospitalization program
- Suffer from a psychiatric residential treatment program
Residential Treatment for SUD
Tricare insurance covers the cost of residential treatment. Residential rehab includes:
- Rehab from SUD conditions
You may be approved for residential treatment if you:
- Contain a primary diagnosis of SUD ( the SUD is the main cause of your symptoms)
- Suffer from severe symptoms
- Contain symptoms that require management by doctors and inpatient monitoring
- Have trouble functioning in several parts of your life as a result of your SUD
Partial Hospitalization Programs (PHP)
Authorized facilities receive Tricare coverage for PHP treatment for mental health and SUDs.
You may qualify if you:
- Are getting treatment in the US and its territories
- Have mental health or SUD problems
- Are able to function in some of your major areas of life with support
- Don’t need full-time hospitalization
- Have serious impairment that interferes with normal functioning
- Require a medically monitored detox
- Require stabilization, have severe symptoms, or are transitioning from an inpatient program
- Are not able to maintain oneself with a lower level of care
Tricare covers the management of your withdrawal symptoms during detox prior to attending:
- Inpatient services
- Opioid treatment programs
- Office-based opioid treatment
- Residential SUD treatment
Mental Health Services
Tricare covers treatment for many types of mental health disorders and SUDs. The treatment that Tricare covers include psychotherapy, which is otherwise known as “talk therapy” or “counseling.” Other inpatient and outpatient services that Tricare covers include:
- Individual and group sessions
- Family sessions
- Psychoanalysis if your provider has the correct certification and it’s preauthorized
- Psychological Testing and Assessment, or evaluation, to diagnose a patient and develop a treatment plan.
- Psychotropic Drugs–These are covered when prescribed as part of a treatment plan.
- Additional Therapies–Tricare covers supplemental therapies when part of a treatment plan at one of the covered facilities as part of a treatment program.
Medication-Assisted Treatment (MAT)
You may qualify for MAT if you have a SUD. Tricare coverage for medication-assisted treatment is a combination of drug and mental health therapies. Tricare members especially receive coverage for medication-assisted treatment if he or she has a special certification from the DEA.
Opioid Treatment Programs (no prior authorization needed for MAT)
Individuals can receive Tricare insurance coverage for an opioid treatment program if they:
- Have an opioid use disorder (OUD)
- Require a medically monitored detox
- Don’t need 24-hour medical support
Office-Based Opioid Treatment
The clinical must conform to regulations from:
- Department of Health and Human Services
- Drug Enforcement Agency
- State and local governments
Is Telehealth Offered?
The Military Health System works to implement health options for individuals while they practice social distancing to fight the COVID-19 pandemic. As a result, Tricare now covers telehealth services for mental health and substance use treatment.
Telehealth choices include mental health and substance use health services including:
- Individual and group psychotherapy
- Crisis management
- Family therapy
- Medication-assisted treatment (during the pandemic only)
- Opioid treatment programs (during the pandemic only)
Tricare will also provide coverage for telehealth Intensive outpatient programs (during pandemic only). These programs include:
- Medication management
- Case management
- Recreational therapy
- Occupational therapy
- Discharge planning
Be sure to talk to your medical provider if you have questions about telehealth services. Depending on one’s Tricare insurance plan, individuals might first need an authorization or referral prior to receiving telehealth services. Ask your regional contractor for help. Likewise, service members on active duty need a referral for telemental health care.
Using Tricare Telehealth Services
You can use a computer, tablet, or smartphone to connect with your medical provider by secure video conferencing. Audio-only telehealth services are also covered by Tricare. Be sure to ask your provider if telehealth services are something that Tricare offers. Not all providers do, and these options can make a big impact on the lives of individuals and their families.
What is Tricare For Life?
Tricare For Life is a Medicare-wraparound coverage that fills the gaps in Medicare Part A and or Tricare beneficiaries. You’re not required to enroll in Tricare For Life. Coverage is automatic if you have Medicare Part A and B. Still, you are responsible for Part B premiums.
Tricare health insurance is also available worldwide. Thus everyone can see any provider you choose. Just know that when retired service members and their families become eligible for Tricare For Life, they are no longer eligible to enroll in Tricare Prime. This event typically occurs at age 65.
Why is Tricare So Important?
Historically, the use of alcohol, illicit drugs, and tobacco are common in the military. As a result, many veterans have trouble adjusting when they return from military service. Post-Traumatic Stress Disorder (PTSD) is a common mental health issue for veterans. Mental health issues and substance abuse frequently go hand in hand for military personnel in and out of active duty.
Heavy drinking is an accepted part of the work culture. It’s used for recreation, as a reward, to ease interpersonal tension, and to promote cohesion amongst people. Alcohol has long been available to members of the military at reduced prices at military bases, including during “happy hours.”
Studies concerning the conflicts of the past decade in Iraq and Afghanistan report that military deployments and combat exposure correlate to increases in alcohol consumption, binge drinking, and heavy drinking. It is thought that these increases in use may be a result of the challenges of war and the stress that it causes.
Alcohol acts as an aid in coping with stressful and traumatic events. It also acts as a form of self-medication for mental health problems.
Service members have also taken part in illicit drug use (cocaine, heroin, marijuana, and the nonmedical use of prescription drugs). Service members use illicit drugs to reduce pain, decrease fatigue, and help with coping with boredom or panic.
During the Vietnam War, service members widely used heroin and opium. It was estimated that almost 43% of those who served in Vietnam used these drugs at least once and 50% were dependent at some time. Of the active-duty members, marijuana is the most widely used illicit drug since the 1980s.
Recently, the misuse of prescription drugs among civilians and military members has become a national health problem. Unfortunately, this misuse has risen more quickly in military rather than civilian populations.
Research shows that the misuse of prescription medications among military personnel is tied to the number of prescriptions doctors write to ease the chronic pain from injuries suffered during more than a decade of continuous war. In fact, service members with prescriptions for pain medications are three times more likely to abuse prescription pain relievers than those who didn’t have a prescription.
Florida Center for Recovery Accepts Tricare Insurance
Whether you’re on active duty or retired, we thank you for your service. Now take care of yourself. Military service can bring on a host of problems that many people can’t really understand.
At Florida Center for Recovery (FCR), we know that you need to talk and need someone who can really listen. We here at FCR also understand that the particular trials and tribulations that keep military personnel addicted to substances. That’s why we make it a priority to treat our military addiction treatment patients with high-quality addiction therapy and care. We are here to help you get through this battle of addiction.
To learn more about Florida Center for Recovery and the different addiction treatment and therapy services that we offer, contact us. We are more than happy to answer your questions and check your insurance. We here at Florida Center for Recovery can help you overcome addiction and start your path towards a bright future.