Tri-Care is a healthcare program specifically for service members and their families all around the world. Tri-Care offers many benefits and is a great form of insurance for those who have it.
Tri-Care Insurance Drug and Alcohol Rehabilitation Coverage FAQs
There are many different aspects to work through as you navigate how to find the best possible treatment at the lowest price and Amethyst can help. Insurance talk may seem confusing at first. We want to make sure you focus on getting better while we navigate through all the details. Keep reading to learn more about what your Tri-Care insurance covers for drug and alcohol rehabilitation.
Does Your Policy Cover Rehab?
Our team of specialists are ready to walk you through every step of the way. When it comes to rehab, Tri-Care has you covered. Tri-Care has a variety of different policies that cover rehab and mental health concerns.
Tri-Care Insurance for Drug and Alcohol Treatment
Tri-Care covers essentially every kind of treatment. If you or a loved one needs inpatient rehabilitation, Tri-Care covers it. The policy also covers detox. As for intensive outpatient programs, you qualify for those too.
In the majority of situations, Tri-Care will need prior approval, or pre-authorization, for substance use treatment. Without this prior approval, patients may need to pay the entire cost of treatment out-of-pocket.
That’s why it’s important to make sure that the treatment center you’ve selected is pre-authorized by Tri-Care. Fortunately, here at Amethyst, we are authorized by Tri-Care. Keep in mind that individuals may also be required to pay a deductible.
Typically, Tri-Care offers coverage for outpatient and intensive outpatient programs, residential (inpatient) programs, and partial hospitalization programs (PHPs).
Tri-Care Policies Work for Addiction Treatment Centers
Tri-Care policies cover essentially every kind of rehab program for addiction treatment centers. Tri-Care has one of the absolute best plans when it comes to treating addiction. Our in-depth view of your policy and the benefits it covers will include:
- What kind of rehabilitation you’re eligible for
- Length of the program that you’ll be able to attend
- Level of Care
By allowing us to provide you with a thorough review of your Tri-Care coverage, we can make the most of your benefits. We’ve been around for quite a while and have our fair share of experience when it comes to insurance.
Tri-Care Covers Inpatient and Outpatient Treatment
Addiction treatment is often a residential or inpatient process. However, you or a loved one can also go through an outpatient program for addiction rehabilitation. The choice between inpatient or outpatient treatment will depend on the unique situation. You don’t need to get prior authorization for emergency services. But you do need approval for ongoing treatment.
Tri-Care covers emergency inpatient hospital services when:
- You have a medical or psychiatric emergency
- You need immediate hospital admission
You will get treatment at the closest hospital that can provide your care. If you have a mental health or substance use disorder, Tri-Care will cover emergency inpatient hospital services for:
- Management of withdrawal symptoms (Detoxification)
- Your stabilization
- Any medical complications you may have from your disorder
Tri-Care covers inpatient psychiatric hospitalization for:
- Diagnosis and treatment of mental health
- Substance use disorders
You may get care in:
- Private psychiatric hospitals
- Local, state, or federal government psychiatric hospitals
These facilities help you with the management of mental health conditions that require:
- Around the clock care
- Medically monitored treatment
You may receive approval for inpatient psychiatric hospitalization if you:
- Pose a serious risk of harm to yourself or others
- Need specialized medication
- Need psychological treatment
- Have a significant impairment in functioning
- Need to be in a hospital full-time
- Are unable to maintain yourself in the community with only outpatient services
Tri-Care covers Intensive Outpatient Programs (IOPs). You may qualify for an IOP if you:
- Have a psychiatric or substance use disorder
- Don’t need to be in a hospital full-time
- Need stabilization, symptom reduction, or prevention of relapse
- Need treatment for partially stabilized mental health disorders
- Need a higher level of care than you’re currently receiving in outpatient care
Are transitioning from an:
- Inpatient program
- Psychiatric residential treatment center
- Partial hospitalization
- Regular outpatient services
Tri-Care covers authorized partial hospitalization program facilities for mental health and substance use disorders. You may qualify for partial hospitalization if you:
- Are seeking treatment in the U.S. and its territories.
- Have mental health or substance use disorder problems.
- Can function with support in some of your major life areas.
- Don’t need to be in a hospital full time.
- Have a significant impairment that interferes with your normal functioning.
- Require medically monitored management of withdrawal symptoms (detoxification) with direct access to medical services.
- Need stabilization, have severe symptoms, need treatment for partially stabilized mental health disorders, or are transitioning from an inpatient program.
- Are unable to maintain yourself in the community with a lower level of outpatient services.
Costs and Services at Inpatient Rehab
Tri-Care covers most of, if not all costs for the majority of inpatient rehab programs. Especially, when it comes to veterans. Tri-Care offers complete benefits to all veterans and active members of the military.
Copayments & Cost-Shares
- Active duty service members pay nothing out-of-pocket for any type of care
- There is no cost for services received at an MTF except for a small per diem when using inpatient care
- For US Family Health Plan and Tri-Care Prime Remote costs, choose “Tri-Care Prime” from the pull-down menu
- You only have to pay the Tri-Care For Life (TFL) Health Plan Costs listed if a service is covered by Tri-Care and not by Medicare. If you are looking for Medicare and Tri-Care covered service costs, download the TFL Cost Matrix.
- Visit the Cost Terms page for definitions to help you better understand Tri-Care costs.
- If you’re not remarried former spouse, for the Continued Health Care Benefit Program (CHCBP), chose “Retired” regardless of your sponsor’s status
Tri-Care Prime includes a point-of-service option. This means you pay higher costs when you don’t have a referral or you use non-network providers without authorization from the Tri-Care regional contractor.
If you have a referral and/or authorization, your costs are the same as network costs. Note: The point-of-service option isn’t available to active duty service members.
Your health insurance plan premium is the payment you make to your health insurance company that keeps your coverage active.
The largest amount you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan will take care of 100% of the costs of covered benefits. The out-of-pocket limit doesn’t cover monthly premiums.
Policy Effective Date
This is the day your insurance company starts to help you take care of your health care expenses. The open enrollment period is typically a set amount of time that occurs once a year, or during a special enrollment period.
Your policy effective date is agreed upon after you’ve enrolled, and generally takes place a few weeks or months after the date of your official enrollment.
This is the amount you pay for covered health care services in a given plan year before your insurance will start to pay for them. Let’s say you have a $2,000 deductible. In this case, you pay the first $2,000 of covered services yourself. After you pay your deductible, your provider will typically pay for the remaining costs.
A copayment is a cost that your health insurance plan requires you to pay to receive a specific medical service or supply. For example, your health insurance plan may require a $15 copayment for medicine at the pharmacy.
Tri-Care Coverage for Mental Health Treatment
Addiction and mental illness go hand in hand most of the time. Although some may think that addiction is merely a physical pain, the truth is that users are often struggling emotionally.
The mental illness can take over, making you or a loved one feel like there is no hope. Many times, these co-occurring disorders can even turn into severe issues in the lives of those close to them. Fortunately, there are dual diagnosis treatment programs that offer help to those who have co-occurring disorders.
Emergency Mental Health Care
You have an emergency if the patient:
- Is at immediate risk of serious harm to self or others as a result of mental disorder
- Needs immediate continuous skilled observation at the acute level of care (based on a psychiatric evaluation)
When you have a mental health emergency:
- Call 911 or go to the nearest emergency room
- You don’t need prior authorization
- If admitted, call your regional contractor within 24 hours or the next business day
- Admissions must be reported within 72 hours
Non-Emergency Mental Health Care
You don’t need to get a referral or prior authorization for any outpatient mental health (except psychoanalysis) and substance use disorder (SUD) care. This includes services like therapy and counseling.
If you choose a provider outside the network, you may pay higher costs. For psychoanalysis or care from an institutional provider outside of a military hospital or clinic, you must get a referral for non-emergency mental health and SUD care.
We don’t want to discourage you from getting help. We want to make sure your condition doesn’t negatively affect your health and ability to perform your duties.
Walking You Through Your Tri-Care Benefits
Here are some other benefits as a Tri-Care policyholder with our facility:
- We’ll do an in-depth review and take you through your Tri-Care health insurance plan.
- We’ll help you determine if you are covered for substance abuse treatment.
- We’ll help decide what kind of treatment and how much is covered.
- Tri-Care health insurance is accepted by almost every treatment center in the U.S., so we’ll go through which ones will work best with your policy.
Tri-Care Programs and Resources for Veterans and Active Duty Members
Do you need help after your deployment? This is for service members, veterans, and military families.
Coast Guard Employee Assistance Program (EAP)
You can get confidential help before a concern becomes a crisis. This is for U.S. Coast Guard members, civilians, and their families.
Call to get help with personal problems and life challenges. This is for U.S. Coast Guard members and their families.
Are you transferring to a new location or separating from active duty? Are you between mental health care providers? Call to get help while you’re in transition.
Military Crisis Line
Are you a veteran or service member in crisis? Or are you concerned about one? You can call, chat online, or send a text message to reach trained professionals at any time.
Military OneSource is a Department of Defense-funded program that’s both a call center and a website. It provides comprehensive information, resources, and assistance on every aspect of military life. Service members and the families of active duty, National Guard and Reserve (regardless of activation status), Coast Guard when activated for the Navy, DoD expeditionary civilians, and survivors are eligible for Military OneSource services which are available worldwide 24/7 at no cost to the user.
Operation Live Well
We are dedicated to your health and wellness. Find tools and resources to maintain a healthy lifestyle.
You can get help building your resilience, facilitating your recovery, and reintegrating. This is for returning service members, veterans, and their families.
Amethyst Is Here for You
Here at Amethyst, we care about our patients. It is our priority to make this process as smooth as possible for you. Insurance can be a complex topic, but we like to simplify it. Making sure you get the most out of your policy and benefits is crucial. Remember, there are brighter days ahead. Give us a call at 888-447-7724 or contact us here, and let us take the first step with you on the road to recovery.