TRICARE Coverage for Rehab in Orange County

TRICARE Plans We Accept

A Better Life Recovery accepts all TRICARE plans. They include:

• TRICARE Prime

TRICARE Prime works much like a traditional health maintenance organization (HMO) health plan.

If you are a TRICARE Prime enrollee, you will be assigned a primary care manager (PCM) who will oversee all your medical care and provide you with referrals to specialists. Only after a referral and authorization from the PCM can your rehab care be initiated.

TRICARE Prime has the lowest out-of-pocket costs if you stay in-network. It operates as a managed care plan, so you will not be covered if you go out-of-network or begin your treatment without a PCM referral.

• TRICARE Select

TRICARE Select is just like a preferred provider organization (PPO) plan, and it gives patients more freedom to choose their providers. With Select, you do not need a referral to start your rehab treatment.

You are also allowed to choose an out-of-network provider and still get a share of your treatment covered. However, using in-network providers will reduce your out-of-pocket costs.

• TRICARE Reserve Select

This plan is for qualified members of the Selected Reserve and their families. It functions very similarly to TRICARE Select, but it also requires monthly premiums in addition to standard cost-sharing.

Under this plan, you have the freedom to contact TRICARE-authorized rehab providers without a referral. Only certain types of care, for example, inpatient substance use treatment or longer rehabilitation stays, may require preauthorization to confirm that your treatment is medically necessary.

• TRICARE Retired Reserve

TRICARE has a dedicated insurance plan for retired members of the Reserve component who have not yet reached age 60 and, therefore, are not eligible for full retired military health benefits. The plan requires monthly premiums and has similar coverage benefits to TRICARE Select.

A TRICARE Retired Reserve beneficiary can choose their own rehabilitation providers, which also includes civilian treatment centers that accept TRICARE.

• TRICARE Young Adult

TRICARE Young Adult allows eligible adult children of service members to maintain TRICARE coverage until age 26. There are two versions of this policy:

1. TRICARE Young Adult Prime
2. TRICARE Young Adult Select

The Prime plan is exactly like TRICARE Prime, where a primary care manager coordinates your care, and you need referrals before seeing specialists.

The Select version allows young adults to contact TRICARE-authorized rehab providers directly in most cases.

• TRICARE for Life (Medicare Wraparound)

TRICARE For Life is available only to military retirees and eligible family members who are enrolled in Medicare Part A and Part B. In this plan, Medicare is your primary insurer, and TRICARE acts as secondary coverage.

Any time you need rehab services, Medicare will process the claim first. If the service is covered under Medicare, TRICARE will pay many of the remaining eligible costs for your treatment.

The availability of rehab treatment, therefore, depends on Medicare approval. You must also seek care from Medicare-participating facilities or providers.

• US Family Health Plan

The US Family Health Plan is a TRICARE option delivered through select civilian healthcare systems rather than military treatment facilities. The plan works similarly to TRICARE Prime, such that your care is coordinated through a designated primary care physician.

If you need rehab, the primary care physician will evaluate you and provide you with a referral to a rehabilitation program within the plan’s network.

TRICARE Select is just like a preferred provider organization (PPO) plan, and it gives patients more freedom to choose their providers. With Select, you do not need a referral to start your rehab treatment.

You are also allowed to choose an out-of-network provider and still get a share of your treatment covered. However, using in-network providers will reduce your out-of-pocket costs.

Who Is Eligible for TRICARE?

TRICARE is essentially a health care program for members of the United States military community. It extends to current service members, their families, and certain other groups connected to the military.

Your eligibility for TRICARE is verified through the Defense Enrollment Eligibility Reporting System (DEERS).² Once you are registered, you can enroll in any of the TRICARE plans discussed above that best fit your situation.

You qualify for TRICARE coverage if you are:

• An active duty service member (Army, Navy, Air Force, Marines, Coast Guard, or Space Force)
• A member of the National Guard and Reserve
• A service member who completed the required years of military service and retired from the armed forces
• A spouse or child of an eligible service member. Dependents are covered until age 21, or age 23 if they are full-time students
• A family member of a service member who has passed away
• An individual awarded the Medal of Honor, one of the nation’s highest military decorations. Such people are eligible for TRICARE benefits regardless of their duty status

What Does TRICARE Cover for Addiction Treatment?

TRICARE covers addiction treatment as a medical condition, which means your care is covered when it is considered medically necessary and provided by approved facilities.

Below are some of the core services covered under TRICARE for addiction treatment:

Detox and Medical Services

Withdrawal can have serious physical or psychological symptoms. So, medical detoxification is often the first line of treatment in rehab. It is delivered to help your body safely clear drugs or alcohol while your active symptoms of withdrawal are being managed.

Your treatment may include:

• • Withdrawal management
  • Medication management to reduce discomfort
  • Medication-assisted treatment (MAT), an FDA-approved approach that combines medications with counselling for opioid and alcohol addiction rehab
  • Medical evaluations
  • Regular monitoring by medical professionals

Residential Treatment

TRICARE also covers residential or inpatient rehabilitation, which delivers structured care in a live-in treatment setting. Your coverage includes room and board as part of inpatient rehab when the program is medically necessary.

You will also get 24-hour clinical supervision so that medical staff and counselors can respond to your needs immediately as needed.

The core aspect of residential care is therapy. So you will participate in individual counseling sessions for one-on-one therapy and group therapy sessions where you connect with others facing similar challenges. Some programs also include family therapy as needed.

Mental Health Treatment

The coexistence of mental health disorders and substance use disorder is high among veterans.

Therefore, TRICARE addiction treatment covers the treatment for post-traumatic stress disorder (PTSD) and combat-related trauma in service members.

Your care will also include specialized treatment for depression, anxiety disorders, and other mental health conditions if needed.

Different types of evidence-based therapies may be used for mental health treatment, such as:

 

• • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Eye movement desensitization and reprocessing (EMDR)
  • Cognitive processing therapy (CPT)

Step 1: Reach Out Anytime

The first step is to reach out to the admissions team at A Better Life Recovery so they can walk you through the verification process.

You can either:

• Call (866) 610-4114 to speak with an admissions specialist Or Submit our online insurance verification form

Both options are available 24 hours a day, seven days a week for your convenience.

Step 2: Provide Your TRICARE Information

Once you connect with the admissions team, you will be asked for a few basic details about your TRICARE coverage. We will use this information to confirm your eligibility and benefits.

You may be asked for your:

• • TRICARE beneficiary ID, which is usually the DoD ID number listed on your military identification card
  • Sponsor’s information if you are covered under a family member’s plan
  • Your TRICARE plan type
  • Your TRICARE region

Step 3: We Verify Your Benefits

After receiving your information, our team will contact TRICARE directly to confirm your benefits.

During this process, we will review the level of coverage available to you. We will also consider any out-of-pocket costs you might have to pay in your treatment, and whether prior authorization will be required before your treatment begins.

Step 2: Review Your Options

Once the verification process is complete, we will go over the results with you in clear, straightforward language so you understand your benefits.

We will also discuss any cost-shares or copays that may apply under your plan. You will have the opportunity to ask any questions you may have.

There is no pressure and absolutely no obligation for you to continue treatment at A Better Life Recovery. But we’re still here to help you understand your options.