Utilizing TRICARE Insurance

TRICARE Provides Coverage for Military Personnel, Retirees, and Their Families

TRICARE^® is a healthcare program of the United States Department of Defense Military Health System that provides health insurance to military personnel, retirees, and their families. Established to ensure that those who serve or have served the country receive adequate medical care, TRICARE offers a wide range of healthcare plans tailored to the specific needs of its beneficiaries.

Eligibility for TRICARE Insurance

Eligibility for TRICARE insurance is determined by the beneficiary’s relationship to the military service member and their status. The main categories of eligible individuals include:

• Active-duty military service members and their families
• National Guard/Reserve members and their families
• Retired military service members and their families
• Medal of Honor recipients and their families
• Survivors of deceased military members
• Some former spouses

To confirm eligibility and enroll in TRICARE insurance, beneficiaries can visit the Defense Enrollment Eligibility Reporting System (DEERS).

Coverage and Benefits

TRICARE offers extensive coverage, including:

• Mental Health Treatment Services: Counseling, therapy, outpatient and residential treatment, and psychiatric care
• Preventive Care: Routine check-ups, screenings, and immunizations
• Emergency and Urgent Care: Coverage for emergency room visits and urgent care services
• Hospitalization: Inpatient and outpatient hospital services, including surgeries
• Prescription Drugs: Coverage for medications through military pharmacies, TRICARE Pharmacy Home Delivery, and retail network pharmacies
• Specialty Care: Access to specialists, such as cardiologists, oncologists, and dermatologists

Costs Associated with TRICARE Insurance

While TRICARE is generally affordable, costs vary depending on the plan, service, and beneficiary’s category. Costs may include:

• Enrollment Fees: These are applicable for some plans, such as TRICARE Reserve Select and TRICARE Retired Reserve.
• Deductibles: This is the amount beneficiaries must pay out-of-pocket before TRICARE begins to cover expenses, but the amount varies based on the specific plan and beneficiary category.
• Co-pays/Cost Shares: Depending on the service and plan, these are fixed amounts or percentages of the cost for specific services, such as doctor visits or prescription drugs. 
• Catastrophic Cap: This is the maximum amount beneficiaries will pay out-of-pocket annually for covered services. Once this cap is reached, TRICARE covers 100% of additional costs for the rest of the year.

Navigating TRICARE Insurance

Navigating TRICARE can be complex, especially with the various plans and options available. Beneficiaries are encouraged to:

• Understand Their Plan: Familiarize themselves with their specific TRICARE plan to understand coverage, costs, and requirements.
• Use In-Network Providers: Whenever possible, use providers within the TRICARE network to minimize out-of-pocket expenses. Muir Wood Adolescent and Family Services is one such treatment provider.
• Take Advantage of Preventive Services: Many preventive services are fully covered by TRICARE, helping beneficiaries maintain good health and catch potential issues early.

TRICARE is a vital resource for military personnel, retirees, and their families, providing comprehensive healthcare coverage tailored to their unique needs. By understanding the different plans, eligibility requirements, and benefits, beneficiaries can make informed decisions about their healthcare and ensure they receive the best possible care through the TRICARE program.

TRICARE Insurance Coverage for Teen Mental Health and Substance Use Treatment

Mental health and substance use treatment are critical components of comprehensive healthcare, especially for military personnel, retirees, and their family members. TRICARE offers extensive coverage for a wide range of mental health services and substance use disorder (SUD) treatments This article provides an overview of mental health and substance use treatment options covered by TRICARE insurance for teens of military families, including eligibility, types of services, and how to access care.

Eligibility of Coverage for Teen Mental Health and Teen Substance Use Treatment

TRICARE provides mental health and substance use disorder coverage for children of eligible military beneficiaries, including active-duty service members, retirees, and reservists. Coverage is available through the various TRICARE plans, including TRICARE Prime, TRICARE Select, TRICARE For Life, and others. Children of policy holders do not need to have a pre-existing diagnosis to access mental health treatment, and they can seek care for a broad spectrum of conditions, ranging from anxiety and depression to more severe psychiatric disorders and substance use issues.

Types of Covered Teen Mental Health Treatment Services

TRICARE insurance covers a wide array of teen mental health treatment services, including both outpatient and inpatient/residential care. The following are some of the services available:

• Outpatient Services:
  • Individual Therapy: One-on-one sessions with a licensed mental health provider, such as a psychiatrist, psychologist, therapist, or clinical social worker. Therapy can address issues like teen depression, anxiety, PTSD, relationship problems, and more.
  • Group Therapy: Sessions led by a mental health professional that include multiple participants. These are often focused on shared experiences or conditions, such as trauma recovery or substance use support groups.Family Therapy: Therapy involving family members to address family system and relational issues or to support a loved one experiencing mental health challenges. Depending on the treatment facility, this may be done in-person or virtually.
  • Medication Management: Psychiatric care that includes the prescription and management of medications for mental health conditions. This establishes a safety protocol for teens.
• Inpatient/Residential Treatment Services:
  • Residential Teen Treatment Centers (RTCs): Long-term care facilities for adolescents who require ongoing mental health treatment in a residential setting. This includes centers that are convenient for military teens.
  • Acute Inpatient Psychiatric Care: Hospitalization for teens in crisis. It provides a controlled environment for those who require immediate and intensive treatment.
  • Partial Hospitalization Programs (PHPs): Structured day programs that provide intensive treatment. This is similar to inpatient care but allows teens to return home in the evening.
• Other Specialized Services:
  • Psychological Testing and Assessment: Comprehensive evaluations to diagnose mental health conditions or to assess cognitive and emotional functioning in teens. Prior authorization may be required.

Coverage for Treatment of Substance Use Disorders (SUD) in Teens 

TRICARE also provides extensive coverage for the treatment of substance use disorders, including both outpatient and inpatient options. Teen substance abuse disorder treatment options include:

• Outpatient SUD Services
  • Individual and Group Counseling: Counseling sessions focused on addressing substance use and developing strategies for maintaining sobriety.Intensive Outpatient Programs (IOPs): Structured programs that offer more intensive care than traditional outpatient services, often including multiple therapy sessions per week.
  • Medication-Assisted Treatment (MAT): The use of medications, in combination with counseling and behavioral therapies, to treat substance use disorders, particularly opioid dependence.
• Inpatient Teen SUD Services:
  • Detoxification: Medical supervision to manage withdrawal symptoms and stabilize teens during the initial stages of recovery.
  • Residential Teen SUD Treatment: Long-term treatment in a residential setting, providing a structured environment for teens who need more intensive care.
  • Inpatient Rehabilitation: Comprehensive, hospital-based treatment programs for severe cases of teen substance use disorder, often including detoxification, counseling, and aftercare planning.

Accessing Teen Mental Health and SUD Services Under TRICARE

To access teen mental health and teen substance use disorder treatment services under TRICARE, beneficiaries should follow these steps:

1. Referral and Authorization: For most outpatient mental health treatment services, including therapy and medication management, a referral from a Primary Care Manager (PCM) is not required under TRICARE Select, although it may be needed under TRICARE Prime. Inpatient care, partial hospitalization, and residential treatment typically require prior authorization.
2. Choosing a Provider: Beneficiaries can choose from a wide network of TRICARE-authorized providers, including both military and civilian mental health professionals. For the lowest out-of-pocket costs, it’s advisable to select in-network providers such as Muir Wood.
3. Emergency Mental Health Care: In emergencies, beneficiaries can seek immediate care at any emergency facility. TRICARE insurance covers emergency mental health and substance use disorder treatment services for teens. Emergencies do not require prior authorization.

Muir Wood Teen is an In-Network Treatment Provider with TRICARE Insurance

TRICARE Insurance’s comprehensive coverage for teen mental health and teen substance use disorder treatment ensures that active military personnel, retirees, and their families have access to the care they need. With a wide range of services, from individual therapy to intensive inpatient and residential treatment programs, TRICARE provides the necessary support to address teen mental health challenges and teen substance use disorders. By understanding the available options and how to access care, beneficiaries can make informed decisions to support their teens’ mental well-being and recovery journey. Get your teen started on their recovery journey by completing our insurance verification form.