TRICARE, which was previously known as the Civilian Health and Medical Program of the Uniformed Services, is an insurance program for active and veterans of the United States Armed Forces as well as their families. TRICARE offers a variety of plan options, including standard, prime, extra, and family plans. Drug rehab coverage from TRICARE varies based on the type of plan you hold and the specifics of the drug rehab programs you choose.
Does TRICARE Cover Drug And Alcohol Detoxification?
TRICARE recognizes the health risks that can come along with withdrawal symptoms of certain types of addiction. Withdrawals from benzodiazepines (Xanax, Valium, Klonopin, etc) can be life-threatening, deeming a medical detox ‘medically necessary’ for the well-being of the patient. While opioid (heroin, fentanyl, morphine, etc) withdrawals are not life-threatening, they are often deemed medically-necessary as the first step in an addiction treatment program.
Most commonly prescribed for patients with dependence on drugs over a prolonged period of time, medical detox programs use a variety of approaches to ensure the drug is flushed from your system with minimal negative side effects. These side effects, or symptoms withdrawal, are sometimes categorized as life-threatening and can include:
- Nausea and vomiting leading to weight loss
- Night terrors
- “Phantom pains” resulting from the over triggering of nerve endings
- Depression and suicidal thoughts
- Paranoia and agitation
- Cold sweats
- Seizures leading to coma or death
TRICARE will cover several types of medical detox facilities including:
- Emergency inpatient services
- Partial hospitalization programs (PHPs)
- Residential (Inpatient) Drug and Alcohol Detox Centers
Medical detox is intended to assist patients in combating the physical and chemical addiction to substances, focusing on ridding your system of the drug to break the cycle of addiction.
TRICARE Inpatient Drug Rehab Coverage
While detox focuses on the physical dependence of substance abuse, this is only one facet of the addiction cycle. The remainder is a mental and behavioral cycle that is difficult to break. Inpatient drug rehab facilities are designed to help individuals identify and break the mental, emotional, and behavioral chains associated with their addiction or substance abuse disorder.
At an inpatient drug rehab center, a patient will actually reside at the rehab facility full time for the entirety of their program. This allows the patient to remove themselves from the temptations and enablers of their addiction. This step is essential in the road to sobriety, because it allows a patient to focus entirely on their treatment.
Inpatient rehab greatly reduces the chance for a relapse down the road because it helps to identify the how and why behind their addiction. Understanding why an individual turned to a drug in the first place can help that person guide their life in a direction that won’t put them back in the same place they started.
Treating and understanding the emotional and behavioral side of a is something that TRICARE believes in and supports.
TRICARE will cover residential or inpatient drug and alcohol rehab programs if the following criteria are met:
- Patient has a substance abuse diagnosis
- Patient has withdrawal symptoms that are severe enough for physician management
- Patient has symptoms that require 24 hour monitoring
- Patient struggles to function in several major life area
- Patient must live in the United States or in a US Territory
There are some inpatient drug and alcohol rehab centers that offer medical detoxification programs as well, which can make the transition from the detox program to the inpatient program easier on a patient. Some detox centers are standalone facilities that work with physicians and therapists at inpatient and outpatient rehab programs to continue with their addiction treatment plan. Regardless of referrals or recommendations given by standalone detox centers, the patient always holds the power to choose their inpatient and outpatient rehab programs.
What Other Addiction Treatment Services Does TRICARE Cover?
In addition to coverage for detox, inpatient, and outpatient drug rehab programs, TRICARE is also proud to offer coverage for the following substance abuse and addiction services:
- Emergency inpatient services
- Medication-assisted treatment (I.E Suboxone for Opioid Addiction)
- Mental health therapeutic services
- Partial hospitalization programs (PHPs) for drug and alcohol addiction
For emergency inpatient services, you are eligible for coverage related to drug overdose or adverse reaction to a drug or drug combination. These services can be administered at the closest available hospital that is able to provide you the care. Emergency inpatient services will also cover you for detoxification, stabilization, and any complications related to the hospitalization. The same criteria is set for partial hospitalization coverage.
Medication-assisted treatment (MAT) is only available for individuals suffering from an opioid addiction. This treatment must be accompanied by a mental health therapy as well, known as multidisciplinary approach. TRICARE will only cover medication prescribed by a TRICARE authorized physician, and the physician must have a special certification given by the DEA to legally prescribe medications used in treating opioid addiction. It is important to note that these medications, such as Suboxone, can also be very addictive. Be sure to consult with your physician to determine if medication-assisted treatment is right for you.
The success of mental health therapies can vary widely from patient to patient. Sometimes multiple services must be tried before a successful one can be found. Some mental health therapies can also be used simultaneously to create the result your therapist is looking for. Be open with your physician about your thoughts and concerns regarding any mental health therapy.
TRICARE will cover the following mental health services:
- Psychological testing and assessment
- Psychotropic drugs
- Electroconvulsive treatment
- Collateral visits
- Other ancillary therapies
Addiction Treatment Programs TRICARE Does Not Cover
While TRICARE does offer coverage for a wide variety of substance abuse and addiction treatment programs, there are a few programs that it will not cover. These programs include:
- Aversion therapy
- Domiciliary facilities (such as halfway houses, supervised living, etc)
- Other experimental therapies
Aversion therapy is a behavior based therapy that attempts to associate an unhealthy habit (such as addiction) with something unpleasing in an attempt to break the individual of that habit. The thought process behind aversion therapy is that an individual will associate their habit or substance abuse with something disgusting or unpleasant. Foul odors and tastes, loud noises, pharmacological stimulants, and even electric shock have been used in this therapy. The effectiveness of aversion therapy related to substance abuse is widely argued, and there is little evidence that it is a good option in lieu of drug rehab programs.
The lack of coverage for domiciliary facilities such as halfway houses is not unusual for most insurance companies. There are many alternative options to domiciliary facilities, such as outpatient rehab treatment, 12-step programs, and aftercare programs, that have proven results and are covered by many insurance plans. It is important to pick the option that fits your needs best and will provide the most support once you return home.
Find A Drug And Alcohol Rehab That Accepts TRICARE Today
Have questions regarding your Tricare coverage for drug rehab been keeping you from searching for a program? We are here to help. Your call is 100% confidential and our addiction treatment specialists are trained to help you find the drug rehab program that works best for your needs and insurance. Contact us today and get started on your road to recovery.