TRICARE Insurance for Veterans

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Published June 25, 2021 

 

If you’re an active-duty service member or a retired veteran, you and your dependents may be eligible for coverage under TRICARE. According to the Military Health System, TRICARE provides coverage for a variety of healthcare services, including substance abuse disorders, to 9.6 million beneficiaries.1 For active-duty service members or veterans struggling with substance abuse, using TRICARE benefits may cover all or part of the cost of rehabilitation.

It’s important to note that coverage may vary by plan choice and location, so it’s important to verify benefits and coverage before seeking drug rehab services.

Table of Contents

What is TRICARE?

TRICARE insurance a government-run healthcare program for veterans, active-duty service members, and their dependents. It provides comprehensive coverage—including healthcare, dental, and prescription coverage as well as benefits for specialized programs—to all beneficiaries and dependents.2

The Department of Defense manages TRICARE and allocates funding for it.3 The insurance is designed to be used by covered individuals when they cannot receive treatment at a military facility.

Although TRICARE is a government-run program, it is not the same as Medicare, Medicaid, or VA healthcare. Medicare is available only to people aged 65 years and up and those with certain disabilities. Medicaid is for low-income individuals, and VA healthcare is for veterans. This means that eligible people can sometimes receive coverage through a combination of TRICARE, Medicare, Medicaid, or VA healthcare benefits. However, understanding how each of these types of insurance operates is crucial to anticipating medical bills and seeking appropriate treatment programs and facilities.

What Health Plans are Offered by TRICARE?

TRICARE health insurance for veterans is available in different plan types with varying degrees of coverage.4 Regardless of plan type, all TRICARE plans provide coverage for service members or veterans and their spouses and dependents. However, some retirees, spouses, and dependents may need to contribute to the cost of coverage. Here is a list of TRICARE network plans.

  • TRICARE Prime —This plan is available to active-duty and retired service members and their families; activated Guard/Reserve members and their families; non-activated Guard/Reserve members and their families who qualify for Transitional Assistance Management Program care; retired Guard/Reserve members aged 60 or older and their families; survivors; Medal of Honor (MOH) recipients and their families; and qualified former spouses.5 Prime plans function similarly to traditional health maintenance organization plans (HMOs) in that a primary care manager facilitates all care. This means you typically have less flexibility in choosing where and from whom you can receive care. Active-duty service members must enroll in TRICARE Prime to receive coverage, while other eligible individuals can choose between Prime and Select Plans. 5 Active-duty members pay nothing out of pocket, nor do family members unless they are utilizing a point-of-service plan option. Other beneficiaries may be required to pay a copayment and enrollment fees. 5
  • TRICARE Select — This relatively new plan replaced TRICARE Standard and TRICARE Extra plans in 2018.6 It is similar to a traditional preferred provider network (PPO) health plan, which means there’s greater flexibility when choosing where and from whom you receive care. In-network providers will receive the best coverage under this plan. Out-of-network providers may not be covered, and if they are, it will be at a lower rate than in-network providers. As with TRICARE Prime plans, active-duty members and their families don’t have to pay enrollment fees for their coverage; nor do those whose sponsor died while in active-duty or those whose sponsor is medically retired.7
  • TRICARE For Life — This TRICARE plan is available for Medicare-eligible retirees and their families. Enrollment is not required, and coverage is automatic so long as you have Medicare Part A and B and you pay Part B premiums.8 You can seek care wherever Medicare is accepted.
  • TRICARE Reserve Select — This TRICARE plan is available for certain people—including non-active-duty members and their families—who aren’t covered under the Transitional Assistance Management Program or ineligible for FEHB program enrollment.9 It is a premium-based plan that operates similarly to a PPO in that care can be obtained at any TRICARE-authorized facility, with cost-sharing requirements and annual deductibles.9
  • TRICARE Retired Reserve — Designed for retired service members, this TRICARE plan is similar to Reserve Select plans.10
  • TRICARE Young Adult — This TRICARE plan is available for purchase by young adults who are between 21 and 26 years of age. College-enrolled adults may still be eligible to be on a parent’s plan until age 23, and those with employer-sponsored healthcare coverage aren’t eligible for enrollment in TRICARE Young Adult.11
  • US Family Health Plan—This TRICARE plan is available to certain people in 6 specific areas of the United States through community-based, non-profit healthcare systems. Unlike other TRICARE plans, you cannot receive care at a military facility with a US Family Health Plan. The plan operates similarly to an HMO. 12 Active-duty members and their families pay no fees, but other eligible people may incur fees.

TRICARE Eligibility Requirements and Coverage

Generally speaking, all active-duty service members and their families are eligible for coverage under TRICARE plans. Certain retired and non-active-duty service members may also be eligible for coverage under TRICARE plans. You can check your eligibility and beneficiary designation here.13

Beneficiaries typically must enroll in their chosen plan through the TRICARE program online, via mail, or in person. Enrollment requirements, including fees, will vary based on plan type and location. Be sure to contact TRICARE for more information.

Do I Need TRICARE if I Have VA Benefits?

VA health benefits and TRICARE are not the same types of healthcare coverage. VA health benefits are for veterans only, while TRICARE benefits are for active-duty members,  veterans and their families. Although enrollment for either type is required, things like enrollment fees, deductibles, and cost-sharing requirements will vary based on the plans selected.

VA benefits must be used at VA facilities to obtain complete coverage. In some cases, covered individuals can seek care outside of VA facilities and still receive coverage.14 TRICARE benefits can be used at a VA facility provided space is available at a location. Retired service members can use their VA health benefits for service-related conditions and their TRICARE coverage for all other care needs.15 The only distinction is if you are eligible for Medicare, as VA facilities are not Medicare-authorized providers. Because Medicare cannot pay for your services at a VA facility, it is wise to enroll in both types of coverage to ensure that you are covered for any type of care you may need.

Do Providers Outside of the VA Take TRICARE?

The short answer to this question is yes; providers outside of the VA network may accept TRICARE. Depending on the TRICARE plan you select, you may be extremely limited to which providers you can see and still obtain full coverage. Other plan types may give you the freedom to visit any provider you’d like, but you may face high costs if the provider isn’t a network provider. Network providers are those who have agreed to participate in the TRICARE network—each region has its own—while non-network providers do not participate. You can check and search for network providers here.16

Does TRICARE Cover Rehab?

Under the Affordable Care Act (ACA), treatment for mental health illnesses is considered an essential health benefit. The ACA mandates that all health plans provide some type of coverage for treatment.17 TRICARE plans may cover the following types of drug rehab treatment in some capacity:18

  • Emergent and non-emergency inpatient services.
  • Outpatient programs.
  • Detox.
  • Medication-assisted treatments.
  • Therapy.
  • Office-based opioid treatment and opioid treatment programs.
  • Partial hospitalization.
  • Residential substance abuse treatment.
  • Certain telehealth services.

The level and type of coverage afforded to you by your plan will vary according to your selected plan and your location. It’s also important to note that TRICARE plans do not provide coverage for unproven treatments or any aversion therapy.18

Does TRICARE Cover Medications?

TRICARE substance abuse benefits typically provide coverage for medication-assisted treatment (MAT), which combines drug and mental health therapies to overcome substance abuse. In most cases, pre-authorization is not required to receive MAT services.

TRICARE drug rehab coverage often covers MAT for opioid abuse when the provider is a TRICARE-authorized provider who complies with DEA, HHS, and state and local government regulations. In most cases, MAT is approved and covered when a beneficiary receives care in an opioid treatment program or office-based opioid treatment. MAT typically includes the following medicaitons:19

  • Suboxone: A name-brand medication containing buprenorphine and naloxone that is used to reverse the side effects of short-acting opioids and prevent or lessen withdrawal symptoms.
  • Buprenorphine: A partial opioid antagonist that diminishes dependency on opioids, lessens withdrawal effects, and lowers the potential for abuse.
  • Methadone: A full opioid antagonist used to reduce cravings for opioids and block the effects of opioids.
  • Naltrexone: A medication used to block effects of opioids and reduce cravings for opioids.
  • Naloxone: A medication used to rapidly reverse the effects of an opioid overdose.

These medications are just a few that may be used in MAT; the list is not exhaustive. What may be available at a specific facility and under your healthcare plan may vary.

What Does TRICARE Not Cover?

TRICARE drug and alcohol treatment typically covers a wide array of treatment options. However, certain treatments, like aversion therapy and unproven methods, are not covered.18 To ensure that a desired treatment method is covered, contact a TRICARE representative.

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Can I Have TRICARE and Other Forms of Insurance?

Depending on your active status in the uniformed forces, you may or may not be permitted to hold another insurance. For example, people on active duty cannot use other health insurance; TRICARE is your only coverage. Under any other circumstance, you can use other forms of insurance (e.g., Medicaid, TRICARE supplements, private employer-sponsored insurance, or Medicare), and this will be the primary payer.20 In other words, your TRICARE coverage will be the last to kick in and provide coverage or payment for services rendered. The benefit of using a combination of insurance coverages, if you’re eligible, is that it may offset any out-of-pocket costs for drug and alcohol rehab and related services and treatments.

TRICARE vs TRIWEST: What’s the Difference?

Although their names are similar, TRICARE and TRIWEST are not the same program. TRICARE is a government-run network of healthcare benefits for active-duty and retired service members and their families. TRIWEST is a healthcare alliance run by a third-party administrator who is contracted with the VA to administer care when a VA facility cannot accommodate the needs of eligible veterans. 3, Page 5 Unlike TRICARE, TRIWEST can be used only by veterans and not by their families. In some cases, however, an eligible person may use both TRICARE and TRIWEST concurrently.

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Sources

  1. Military Health System. (2020). Beneficiary Population Statistics.
  2. TRICARE. About Us.
  3. TRIWEST Health Care Alliance. Billing Frequently Asked Questions.
  4. TRICARE. (2021). Health Plans.
  5. TRICARE. (2020). TRICARE Prime.
  6. TRICARE. (2021). TRICARE Select.
  7. TRICARE. (2021). Frequently Asked Questions.
  8. TRICARE. (2018). TRICARE for Life.
  9. TRICARE. (2020). TRICARE Reserve Select.
  10. TRICARE. (2020). TRICARE Retired Reserves.
  11. TRICARE. (2016). TRICARE Young Adult.
  12. TRICARE. (2018). US Family Health Plan.
  13. TRICARE. (2021). Eligibility.
  14. Department of Veterans Affairs. (2021). Frequently Asked Questions – Health Care Benefits Overview.
  15. TRICARE. (2018). Veterans Affairs Facilities.
  16. TRICARE. (2020). All Provider Directories.
  17. Healthcare.gov. Essential Health Benefits.
  18. TRICARE. (2018) Substance Use Disorder Treatment.
  19. Substance Abuse and Mental Health Services Administration. (2020). MAT Medications, Counseling, and Related Conditions.
  20. TRICARE. (2021). Using Other Health Insurance.