Does TRICARE Insurance Cover Opioid Rehab?
The opioid epidemic in the U.S. is a serious cause for concern. In 2020, there were an estimated 48,006 deaths from opioid overdoses in the United States. That’s approximately 131 deaths per day. Nearly a third of these deaths were due to prescription opioids.1
There are a number of factors that have contributed to the opioid epidemic in the U.S. One factor is the overprescribing of opioids. Close to 92% of opioid users abuse prescription opioids regularly, while pharmacies fill over 150 million opioid prescriptions annually.1
Another factor is the easy availability of opioids. The U.S. Department of Justice has reported that prescription opioids are widely available for sale and purchase illegally on the Internet.2
The opioid epidemic has had a devastating effect on families and communities across the United States. It’s important to be aware of the risks of opioids and seek help if you or someone you know is struggling with an addiction.1
Since opioid abuse rate is very high and frequent among veterans, service members and their families may be wondering whether Tricare covers drug rehab. There is no one-size-fits-all answer to this question, as TRICARE coverage for opioid rehab will typically vary depending on the specific situation. However, in general, TRICARE may cover some or all of the costs of rehab if it is deemed medically necessary under the Affordable Care Act.3.4
An Introduction to TRICARE Insurance
TRICARE is a healthcare program for service members and their families that provides access to military hospitals and medical facilities, as well as civilian health care professionals and facilities. Tricare coverage nationwide offers a wide range of benefits and services, including preventive care, routine checkups and immunizations, hospitalization and surgery, mental health and substance abuse treatment, and prescription drugs.5
TRICARE is administered by the Department of Defense (DoD) and is available to eligible beneficiaries worldwide. Active duty service members, their spouses, veterans, and their families are automatically enrolled in TRICARE Prime, the managed care option of TRICARE.5
What Services Are Included in Tricare Substance Abuse Coverage?
The Affordable Care Act ensures that individuals have access to the same level of coverage for mental health services and substance abuse treatment as they do for physical health services. This means that all medically-necessary services should be included in the coverage, which among others includes:4
Opioid Screenings and Professional Interventions
The screenings and interventions in opioid treatment are important to help those struggling with addiction. The screenings can help determine if someone is addicted to opioids and the interventions can help provide treatment for those who are addicted.4
Opioid Detox
Opioid detox is the first step that helps people overcome addiction to opioids. It can be difficult to withdraw from opioids, but detox can help make the process more manageable. Detox usually involves gradually reducing the dose of opioids over a period of time, until the person is no longer physically dependent on them.4
Inpatient or Outpatient Treatment
Inpatient and outpatient treatment are two different types of treatment available to people struggling with opioid use. Inpatient treatment requires the person to stay in a hospital-like or residential setting for a certain amount of time. With outpatient treatment, on the other hand, the person can come to appointments as needed and then return home.4
Opioid and Co-Occurring Disorder Treatment
Co-occurring disorders are mental health conditions that often occur together with an SUD. Following the intake process at a rehabilitation facility, patients are subjected to a dual diagnosis assessment. If necessary, co-occurring disorders are treated with a combination of therapies, including medication, psychotherapy, and rehabilitation.4
Behavioral Therapies
Behavioral therapies have been found to be highly beneficial for the treatment of opioid abuse. Behavioral therapies involve the use of specific techniques to change a person’s behavior in relation to opioids and their use.4
Are There Treatment Services TRICARE Won’t Cover?
TRICARE insurance coverage only helps pay for opioid treatment services if they are medically necessary. This means that non-medical services like access to a gym or a spa, and food preparation and delivery are not covered and might have to be paid for privately. The same applies to alternative treatment options such as holistic care services, and additional amenities such as same-day treatment center admittance, private rooms or private treatment, and couples rehab for partners who want to be admitted together.4
What Are the Costs of Opioid Rehab?
Determining the cost of opioid rehab can be difficult, as the cost can vary depending on the rehab center and the type of treatment required. However, some general factors that can affect the cost include the location of the center, the length of treatment, and the type of TRICARE insurance coverage you have. The costs may vary from a few hundred dollars per week to a few thousand per month based on the treatment used.6
Outpatient drug rehab programs typically cost less than inpatient programs, but the cost can still vary depending on the center and the type of treatment required. It’s important to check with your insurance provider to see if they cover the cost of treatment at a particular local center and whether that center is in-network.4
What Are the Costs of Inpatient Opioid Programs?
The cost of inpatient opioid rehab can be determined by a number of different factors. The most significant factors that affect the cost of inpatient opioid rehab are the location of the rehab center and the type of program that is being offered. Other factors that can influence the cost of inpatient opioid rehab include the amenities that are offered by the rehab center and the length of stay that is required.7
It’s important to keep in mind that the cost of inpatient opioid rehab is only one factor to consider when choosing a treatment center. The quality of care provided by the staff at the rehab center and the program’s success rate should also be taken into consideration.7
What Are the Costs of Outpatient Opioid Programs?
Some of the main factors that determine the cost of an outpatient opioid rehab program are the frequency of the required sessions, the duration of the outpatient program, and the services offered. Since outpatient treatment programs don’t involve people residing at the facility, outpatient treatment costs are generally lower than those of inpatient treatment.7
Some insurance plans may cover a portion of the cost of treatment. Additionally, many programs offer financing options for those who cannot afford to pay out-of-pocket.4
What Are the Costs of Partial Hospitalization Programs for Opioid Use?
Partially hospitalized patients (PHPs) typically involve a range of costs based on the type of treatment plan, duration, and frequency of their participation. Partial hospitalization programs usually involve receiving counseling, individual or group therapy, and support group sessions at a treatment center for at least 20 hours a week.4
What Are the Costs of Medication-Assisted Treatment for Opioid Use?
Medication-assisted treatment (MAT) for opioid use may vary in cost based on the treatment a patient receives. The costs of medication-assisted treatment also include regular drug counseling, administration, testing, and associated services. For methadone treatment, patients can expect to pay close to $6,500 per year, while naltrexone treatment may cost close to $14,000.6
How Do Costs of Treatment Compare to the Costs of Addiction to Opioids?
The total cost of opioid use disorders in the United States was a staggering $78 billion in 2013. Of that, only a small portion was spent on treatment. Yet, if left untreated, addiction can lead to a variety of other costs, such as criminal justice expenses, the greater transmission of infectious diseases, and overdoses.6
Only 2.6 million received treatment in a treatment facility in 2010, even though 23.1 million Americans aged 12 or older needed treatment for substance abuse. Intervention is critical, as early substance use can progress to addiction and cost society millions of dollars. Treatment is also more effective and affordable than most people think. In fact, almost $4 in public health and $7 in criminal justice and law enforcement costs can be saved for every dollar spent on substance abuse treatment.8
What Length of Treatment is Covered in TRICARE Opioid Rehab?
TRICARE insurance plans offer a variety of coverage lengths and modalities, so the length of treatment covered typically varies depending on your specific policy. To find out more about your insurance plan, you can contact the TRICARE hotline for additional information. You can find the number located on the back of your insurance card. Their insurance agents will be able to help you determine what length of treatment is covered by your policy and provide a list of in-network facilities.4
It’s important to note that the amount of time spent in treatment is often directly correlated with an individual’s chances of recovery. Addressing opioid addiction usually takes a significant amount of time, with treatment lasting anywhere from 60 to 90 days in an inpatient setting, and often requiring maintenance drugs for up to a year or more.9
Following inpatient treatment, some people may transition to outpatient treatment which generally entails attending sessions for fewer hours each week but still provides support. Outpatient treatment can last for several months to a year. However, the longer someone remains committed to their treatment plan, the greater their chances are of successfully overcoming addiction.9
How to Choose Between Inpatient and Outpatient Opioid Rehab?
The choice between inpatient and outpatient rehab is individual and based on several factors such as the severity of addiction, the patient’s mental health and co-occurring disorders, and their living conditions. A struggling individual should make the decision in consultation with their medical professional.7
Inpatient opioid treatment is typically more expensive and is reserved for those with more severe forms of addiction. Outpatient opioid treatment is less expensive and can be accessed by those with less severe struggles. Both treatment options typically include medication and counseling.7
Inpatient treatment is a more intensive form of treatment, where the person lives at the treatment center while they undergo rehabilitation. This type of treatment is usually recommended for people with severe addiction, as it provides around-the-clock care and support.7
Outpatient treatment is less intensive, and the person attends regular sessions at a facility or center. This type of treatment may be recommended for people with mild to moderate addiction, with strong support from their friends and family.7
Treatment for opioid addiction is often long-term and may require multiple different types of interventions. However, with commitment and effort, it is possible to recover completely.7
Opioid Recovery: How Does TRICARE Addiction Treatment Work?
If you are looking for a way to use your Tricare insurance for opioid rehab, you may be wondering how it works. First, you will need to find a rehab center that accepts Tricare. You can do this by checking the website or by calling the Tricare helpline.
If you have any questions or concerns about using your insurance, you can also contact the rehab center directly. They will be able to help you understand your options and help you get the treatment you need. You can reach out to the American Addiction Centers, one of the leaders in the field. You can reach them via an alcohol and drug rehab hotline and connect to the admissions navigators who will explain the process and verify your exact insurance on the spot.
Where Can You Find TRICARE Insurance Drug Treatment Programs?
If you or someone you love is addicted to opioids, it’s important to get adequate help as soon as possible. American Addiction Centers can help verify your insurance coverage and find a Tricare substance abuse treatment facility that meets your needs.
To find a Tricare-approved facility, you can search the website or call the Tricare helpline. You can also call the AAC opioid helpline and speak to a representative who can help you find a treatment facility that accepts your insurance. With the help of American Addiction Centers, you can find a treatment facility that meets your needs and get started on the road to recovery.
