Overview of TRICARE

TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services, is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for Uniformed Service members and their families, National Guard/ Reserve members and their families, survivors, former spouses, medal of honor recipients and their families, and others registered under DEERS (Defense Enrollment Eligibility Reporting System). You must be registered in the DEERS to be eligible for TRICARE. Sponsors are automatically registered in DEERS and sponsors must register eligible family members. If both parents are service members, choose one to be listed as the children’s sponsor in DEERS.

TRICARE is the civilian care component of the Military Health System, although historically it also included health care delivered in the military medical treatment facilities.

TRICARE covers health care, dental care, mental health care, pharmacy, special needs and vision care.

Non-Emergency Mental Health Care

It is not necessary 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 an individual chooses a provider outside the network, they may pay higher costs. 

For psychoanalysis or care from an institutional provider outside of a military hospital or clinic, a referral for non-emergency mental health and SUD care is needed. TRICARE makes a note to all that use this insurance for mental health care needs stating

“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.”

Benefits and plans will vary depending on the beneficiary category the individual falls under:

If you
Then

 

Are an active duty service memberYou need to get a referral and prior authorization for all mental health care.
Are a non-active duty TRICARE Prime beneficiaryYou need to get a referral and prior authorization for psychoanalysis and outpatient therapy for substance use disorder provided by a substance use disorder rehabilitation facility.
Use TRICARE For LifeMedicare is the primary payer for mental health care. You only need a referral or authorization from TRICARE if your Medicare benefits are exhausted.
Use any other TRICARE health planYou need to get a referral and authorization for psychoanalysis and outpatient therapy for substance use disorder provided by a substance use disorder rehabilitation facility.

 

Covered Treatments

TRICARE covers medically and psychologically necessary mental health and substance use disorder care, including both inpatient and outpatient care. Other than individual and group therapy, TRICARE may also cover services that are part of inpatient treatment plans like art therapy. TRICARE covered treatments include:

  • Applied Behavior Analysis
  • Autism Spectrum Disorder
  • Cognitive Rehabilitation Therapy
  • Collateral Visits
  • Drug Testing
  • Eating Disorder Treatment
  • Electroconvulsive Therapy
  • Family Therapy
  • Gender Dysphoria
  • Intensive Outpatient Programs
  • Inpatient Hospital Services (emergency and non-emergency)
  • Management of Withdrawal Symptoms (Detoxification) 
  • Medication Assisted Treatment
  • Office Based Opioid Treatment
  • Opioid Treatment Programs
  • Partial Hospitalization
  • Psychoanalysis
  • Psychological Testing
  • Psychotherapy
  • Psychotropic Drugs
  • Residential Treatment Facility Care
  • Substance Use Disorder Treatment
  • Therapeutic Services
  • Transcranial Magnetic Stimulation

 

ServiceWhat is it?
PsychotherapyAlso known as “therapy” or “counseling.” TRICARE covers inpatient and outpatient services, including:

  • Individual sessions
  • Group sessions
  • Family/Conjoint sessions
PsychoanalysisTRICARE covers psychoanalysis if your:

  • Provider has the correct certification.
  • Treatment is preauthorized.
Psychological Testing & AssessmentTRICARE covers psychological testing and assessment to help diagnose a patient and develop a treatment plan.

TRICARE doesn’t cover psychological testing for academic placement.

Psychotropic DrugsCovered when prescribed by an authorized provider as part of a treatment plan.
Electroconvulsive TreatmentElectroconvulsive treatment (ECT) may be covered.
Collateral VisitsTRICARE covers collateral visits when needed. These visits are between a provider and a family member or other responsible person.
Medication Assisted TreatmentMedication assisted treatment combines medication and mental health therapies for the treatment of substance use disorder.
Ancillary TherapiesTRICARE only covers ancillary therapies as part of the treatment plan at one of the following types of facilities:

  • Inpatient facility
  • Residential substance use disorder treatment
  • Psychiatric residential treatment center (children and adolescents under age 21)
  • Partial hospital program
  • Intensive outpatient program

Therapies include:

  • Art
  • Music
  • Dance
  • Occupational
  • Other ancillary therapies

 

TRICARE does NOT cover all mental health services including:

  • Aversion therapy (including electric shock and the use of chemicals for alcoholism, except for disulfiram, which is covered for the treatment of alcoholism)
  • Behavioral health care services and supplies related solely to obesity and/or weight reduction
  • Bioenergetic therapy
  • Biofeedback for psychosomatic conditions
  • Carbon dioxide therapy
  • Counseling services (i.e. nutritional counseling, stress management, marital therapy, or lifestyle modifications)
  • Custodial nursing care
  • Diagnostic admissions
  • Educational programs
  • Environmental ecological treatments
  • Experimental procedures
  • Filial therapy
  • Guided imagery
  • Hemodialysis for schizophrenia
  • Marathon therapy
  • Megavitamin or orthomolecular therapy
  • Narcotherapy with LSD
  • Primal therapy
  • Psychosurgery
  • Rolfing
  • Sedative action electrostimulation therapy
  • Services and supplies that are not medically or psychologically necessary for the diagnosis and treatment of a covered condition
  • Sexual dysfunction therapy
  • Stellate ganglion block for the treatment of Post-Traumatic Stress Disorder
  • Telephone counseling (except for geographically distant family therapy related to Residential Treatment Center care)
  • Therapy for developmental disorders (i.e. dyslexia, developmental mathematics disorders, developmental language disorders, and developmental articulation disorders)
  • Training analysis
  • Transcendental meditation
  • Z therapy

 

Copays and Cost Shares

  • Active duty service members pay nothing out-of-pocket for any type of care
  • Active duty family members only pay for care when they use: 
    • A TRICARE Prime plan and they get care without a referral*
    • TRICARE Select
    • A network pharmacy or TRICARE Home Delivery 
  • For more information on cost depending on the individual plan visit: https://www.tricare.mil/Costs/Compare

 

References and Additional Resources

  • https://www.TRICARE.mil/Plans/Eligibility
  • https://www.humanamilitary.com/provider/education/
  • http://www.militarycrisisline.net
  • https://www.hhs.gov/programs/topic-sites/mental-health-parity/mental-health-and-addiction-insurance-help/index.html#