Tricare: Definition, Coverage, Application, Benefits, Cost, Alternatives

Tricare provides healthcare services to active-duty military members, retirees, and their families. Tricare offers comprehensive health benefits, including medical, dental, and vision care, across multiple plans to suit the varying needs of military personnel and their families. In fiscal year 2016, TRICARE served 9.4 million military personnel and their family members.

In California, Tricare covers hospital and outpatient care, prescription drugs, mental health services, addiction treatment, and preventive care, ensuring you receive the healthcare you need. 

Eligibility of Tricare includes active-duty service members, retirees, National Guard and Reserve members, survivors, and certain family members, with specific conditions for retirees and former spouses.

Benefits of Tricare include access to a large network of providers, affordable costs, and comprehensive coverage for medical, dental, and mental health services. This is particularly valuable in California, where residents are 5 times more likely to encounter out-of-network barriers for mental health care compared to primary care, and where individuals with mental health conditions spend nearly three times more on healthcare annually ($9,082) than those without such conditions ($3,624).

The costs of Tricare vary based on your plan and status. Active-duty members face little to no out-of-pocket costs, while retirees may have premiums and deductibles, especially with the flexible Tricare Select plan.

If Tricare doesn’t suit you, explore alternatives like the VA Health Care System, private health insurance, or employer-sponsored plans, with the VA offering options with no premium costs for eligible veterans.

What Is Tricare?

Tricare is a health care program managed by the Department of Defense (DoD) that provides medical coverage to active duty military members, retirees, and their families. It is designed to offer comprehensive health services, including medical, dental, and vision care, to those who serve or have served in the U.S. military. 

Tricare works by partnering with a network of civilian and military healthcare providers, ensuring members have access to a wide range of services. The program operates in different plans, offering flexibility based on the user’s status (active duty, reserve, or retired) and location. 

The implementation of the Affordable Care Act (ACA) led to a substantial decrease in the uninsured rate, dropping from 16.0% in 2010 to 8.9% in the first half of 2016. Tricare aims to deliver high-quality, affordable healthcare to eligible beneficiaries both domestically and internationally, depending on the specific plan selected.

What Does Tricare Cover?

Tricare covers a wide range of healthcare services, including addiction treatment, mental health services, therapies, and prescription drugs. Addiction treatments such as counseling, detoxification, and rehabilitation programs are covered, along with mental health services like individual therapy, family therapy, and inpatient care for mental health disorders.

The things Tricare covers are as follows:

• Addiction Treatment: Tricare covers a range of addiction treatment services, including inpatient and outpatient rehabilitation, detoxification programs, and outpatient counseling for substance use disorders. This ensures that members have access to essential care for overcoming addiction. Coverage also includes therapy services aimed at supporting recovery.
• Mental Health Services: Tricare provides coverage for mental health issues, including treatment for conditions such as depression, anxiety, and PTSD. Services include inpatient and outpatient therapy, psychiatric evaluations, and medications for managing mental health disorders. Tricare also offers family therapy to support loved ones during treatment.
• Therapies: Tricare covers a variety of therapeutic services such as physical therapy, occupational therapy, and speech therapy. These therapies are designed to assist with rehabilitation and recovery after surgery, injury, or illness. Tricare ensures that beneficiaries receive the necessary treatments to restore function and improve quality of life.
• Prescription Drugs: Tricare covers prescription medications, including those prescribed for addiction, mental health disorders, and chronic conditions. The program offers access to a wide selection of medications, ensuring that members have the medications they need to manage their health. Tricare’s pharmacy benefit provides both generic and brand-name drugs, depending on the prescription and availability.

What Mental Health Treatments are Covered by Tricare?

The mental health treatments covered by Tricare are comprehensive and include outpatient rehabilitation programs, and outpatient counseling for mental health challenges. Tricare also covers therapy services, such as individual and group counseling, to support long-term recovery and relapse prevention.

Common addiction treatments covered by Tricare include:

• Partial Hospitalization Program (PHP): Tricare’s Partial Hospitalization Program (PHP) offers structured treatment during the day while allowing patients to return home in the evening. This level of care is suitable for individuals who require intensive treatment but do not need round-the-clock supervision. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), PHPs are effective for those with moderate addiction, as they provide comprehensive therapy while allowing flexibility for patients. Tricare ensures that beneficiaries have access to PHP for co-occurring mental health disorders.
• Intensive Outpatient Program (IOP): Tricare provides coverage for Intensive Outpatient Programs (IOP), which offer high levels of therapy for individuals with less severe mental health issues. These programs allow patients to attend treatment several times a week while maintaining their regular daily responsibilities. SAMHSA reports that IOPs are particularly beneficial for individuals transitioning from inpatient care or those who need flexible treatment to continue their recovery. Tricare’s inclusion of IOPs ensures members have ongoing access to essential addiction support.
• Outpatient Mental Health Treatment: Outpatient mental health treatment is covered by Tricare for individuals who need therapy but do not require intensive or residential care. This includes individual counseling, group therapy, and education on managing mental health. According to the National Institute on Drug Abuse (NIDA), outpatient treatment is effective for individuals with mild to moderate substance use disorders, allowing them to receive treatment while living at home. Tricare’s coverage supports ongoing recovery through accessible outpatient services.

What Mental Health Services are Covered by Tricare?

The mental health services covered by Tricare are anxiety, depression, seasonal affective disorder, post-traumatic disorder, OCD, schizophrenia, and bipolar. Tricare also provides coverage for family therapy and support services, ensuring that both individuals and their loved ones receive the necessary care for mental health challenges.

Common mental health services covered by Tricare include:

• Anxiety: Tricare provides coverage for treatment related to anxiety disorders, including generalized anxiety disorder, panic disorder, and social anxiety disorder. Anxiety disorders affect approximately 19% of adults in the United States, according to the Anxiety and Depression Association of America (ADAA). Tricare ensures access to therapy, such as Cognitive Behavioral Therapy (CBT), and medication management to help reduce symptoms and improve daily functioning.
• Depression: Tricare covers treatment for major depressive disorder and other forms of depression, such as persistent depressive disorder. According to the National Institute of Mental Health (NIMH), depression affects about 8.4% of adults in the U.S., with higher rates in veterans. Tricare provides both psychotherapy and medication options, including antidepressants, to manage symptoms and support mental well-being.
• Seasonal Affective Disorder (SAD): Tricare offers coverage for the treatment of Seasonal Affective Disorder, a type of depression that occurs during specific seasons, especially winter. The National Institute of Mental Health (NIMH) reports that around 5% of the U.S. population experiences SAD, causing symptoms such as fatigue, irritability, and changes in sleep and appetite. Tricare covers light therapy, counseling, and antidepressants to help manage this seasonal condition.
  Post-Traumatic Stress Disorder (PTSD): Tricare covers a wide range of services for individuals with Post-Traumatic Stress Disorder, including trauma-focused therapy and medications such as selective serotonin reuptake inhibitors (SSRIs). According to the U.S. Department of Veterans Affairs (VA), about 7-8% of the population will experience PTSD at some point in their lives, with higher rates among military personnel. Tricare offers evidence-based treatments, including cognitive processing therapy (CPT) and prolonged exposure therapy (PE), to help individuals cope with traumatic events.
• Bipolar Disorder: Tricare covers the treatment of bipolar disorder, including medications (mood stabilizers, antipsychotics) and therapy. According to the National Institute of Mental Health (NIMH), bipolar disorder affects about 2.8% of adults in the U.S. Tricare provides comprehensive care, combining psychotherapy and pharmacotherapy to manage mood swings and prevent episodes of mania and depression.
• Schizophrenia: Tricare provides access to treatment for schizophrenia, including antipsychotic medications and specialized therapy programs. Schizophrenia affects approximately 1.1% of the U.S. population, as reported by the National Institutes of Health (NIH). Tricare ensures individuals with schizophrenia receive the care needed to manage symptoms and improve their quality of life.
• Obsessive-Compulsive Disorder (OCD): Tricare covers treatment for Obsessive-Compulsive Disorder (OCD), which includes exposure and response prevention therapy (ERP) and medication. The International OCD Foundation reports that approximately 1.2% of the U.S. population experiences OCD during their lifetime. Tricare’s coverage includes access to evidence-based therapies and medications to help manage compulsive behaviors and obsessive thoughts.

Does Tricare Cover Therapy?

Yes, Tricare covers therapy for a variety of mental health conditions, including individual counseling, family therapy, and group therapy. These services are available to beneficiaries both in inpatient and outpatient settings, depending on the individual’s treatment needs.

The Tricare covers include:

• Individual Therapy: Tricare provides coverage for individual therapy, where patients receive one-on-one counseling with a licensed therapist. This therapy is effective for treating conditions like anxiety, depression, and PTSD, with Cognitive Behavioral Therapy (CBT) being a commonly used approach. According to the National Institute of Mental Health (NIMH), CBT has been shown to be highly effective, with studies indicating that 60-80% of patients with anxiety and depression show improvement after CBT. Tricare ensures that individuals have access to personalized treatment plans to address their specific mental health needs.
• Family Therapy: Tricare covers family therapy, which involves family members working together with a therapist to address relational issues and support an individual’s recovery process. This therapy is particularly effective for treating adolescent behavioral problems, substance use disorders, and mental health disorders like depression. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), family therapy has shown positive outcomes, with studies indicating a 40-60% reduction in relapse rates for individuals with substance use disorders. Tricare ensures that families have the resources to improve communication and create a supportive environment.
  Group Therapy: Tricare covers group therapy, where patients participate in therapy sessions with others facing similar challenges, facilitated by a licensed therapist. Group therapy is effective for treating addiction, trauma, and mental health disorders, as it provides peer support and a sense of community. A study by the National Institute on Drug Abuse (NIDA) found that group therapy, especially when combined with other treatments like CBT, significantly reduces substance abuse relapse rates, showing effectiveness in 50-70% of participants. Tricare supports group therapy as a crucial tool in fostering recovery through social interaction and shared experiences.

Does Tricare Cover Prescription Drugs?

Yes, Tricare covers prescription drugs, including medications prescribed for a variety of conditions such as mental health disorders, chronic illnesses, and addiction treatments. Tricare’s pharmacy benefit ensures that beneficiaries have access to both brand-name and generic drugs, depending on the prescription. Covered medications include those for managing conditions like depression, anxiety, PTSD, and substance use disorders.

The types of prescription drugs covered by Tricare:

• Antidepressants: Medications such as SSRIs and SNRIs to treat conditions like depression and anxiety.
• Antipsychotics: Used for managing conditions like schizophrenia and bipolar disorder.
• Anti-anxiety Medications: Drugs like benzodiazepines and other sedatives for anxiety disorders.
• Substance Use Disorder Medications: Medications such as methadone and buprenorphine for addiction treatment.
• Pain Management Medications: Opioids and non-opioid medications for chronic pain management, as prescribed by a healthcare provider.

What Does Tricare Not Cover?

Tricare does not cover mental health treatment services, such as aversion therapy, elective psychotherapy and mind expansion psychotherapy, neurofeedback, and therapeutic absences from inpatient facilities. 

Aversion therapy, which involves using unpleasant stimuli to discourage certain behaviors, is not covered due to concerns about its effectiveness and ethical considerations in the treatment of addiction. 

Elective psychotherapy and mind expansion psychotherapy are not covered because they fall outside the scope of evidence-based treatment practices and are not recognized as standard treatment options for addiction.

Neurofeedback, which is used to train brainwave activity to treat various conditions, is not covered by Tricare due to limited scientific evidence supporting its efficacy for addiction treatment. 

Lastly, therapeutic absences from inpatient facilities are not covered, as they are seen as a non-therapeutic activity that interfere with the structured environment necessary for recovery. These exclusions are based on the need for treatments to be both evidence-based and clinically effective, ensuring that Tricare beneficiaries receive the highest standard of care.

Who Is Eligible for Tricare?

Active duty military members, retirees, and their families are eligible for Tricare. Additionally, National Guard and Reserve members, as well as certain surviving dependents, also qualify for coverage under Tricare.

The eligibility criteria for joining Tricare include the following:

• Active Duty Service Members and Families: Active duty members of the military and their immediate family members are eligible for Tricare coverage. This includes service members from the Army, Navy, Air Force, Marines, and Coast Guard.
• National Guard and Reserve Members and Families: Members of the National Guard and Reserve components, along with their families, qualify for Tricare benefits when activated for service or during specific reserve duty periods.
• Retired Service Members and Families: Retired military members and their families are eligible for Tricare after leaving active duty, with access to the same health benefits they had while serving.
• Retired Reserve Members and Families: Retired Reserve members, along with their families, qualify for Tricare coverage under specific conditions after completing their service requirements.
• Beneficiaries Eligible for TRICARE and Medicare: Individuals who are eligible for both Tricare and Medicare receive healthcare services through a combined coverage plan, maximizing their healthcare benefits.
• Survivors: Survivors of active duty service members or retirees, including spouses and dependent children, are eligible for continued Tricare coverage.
• Children: Dependent children of active duty and retired service members, as well as National Guard and Reserve members, qualify for Tricare coverage until they reach the age limit specified by their status.
• Former Spouses: Former spouses of military service members qualify for Tricare under specific conditions, such as the length of the marriage and the member’s service.
• Medal of Honor Recipients and Families: Tricare extends healthcare benefits to Medal of Honor recipients and their families, offering full healthcare coverage as a special recognition of their service.
• Dependent Parents and Parents-in-Law: Tricare coverage is available to dependent parents and parents-in-law of eligible service members under specific circumstances.
• Foreign Force Members and Families: Members of foreign military forces, as well as their families, are eligible for Tricare under certain international agreements between the U.S. and foreign governments.

What Are the Different Health Plans for Tricare?

The different health plans for Tricare are TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Option, TRICARE Overseas TRICARE Prime Remote Overseas, TRICARE Select, TRICARE Select Overseas, TRICARE For Life, TRICARE Reserve Select, and TRICARE Retired Reserve. These health plans are designed to meet the unique needs of its beneficiaries, based on their location and status. 

Each plan provides varying levels of coverage, with some plans tailored to active duty members, retirees, and their families, while others are specifically designed for those living overseas or in remote areas.

• TRICARE Prime: A managed care plan that provides comprehensive coverage with a primary care manager (PCM) directing healthcare services. It is available to active duty service members and their families in designated areas.
• TRICARE Prime Remote: For active duty service members and families living in remote locations, offering the same coverage as TRICARE Prime but with different access rules for healthcare providers.
• TRICARE Prime Option – US Family Health Plan: A network of healthcare providers that provides services similar to TRICARE Prime but managed by non-DoD organizations, available in certain regions of the U.S.
• TRICARE Prime Overseas: A plan for active duty service members and their families living overseas, offering managed care services in international locations.
• TRICARE Prime Remote Overseas: Similar to TRICARE Prime Overseas, this plan is for active duty service members and their families living in remote overseas locations where access to healthcare is limited.
• TRICARE Select: A fee-for-service plan offering more flexibility in choosing healthcare providers and no requirement for a primary care manager, available to retirees, National Guard, and Reserve members.
• TRICARE Select Overseas: Provides the same fee-for-service benefits as TRICARE Select but is specifically for beneficiaries living overseas.
• TRICARE For Life: A plan available for retirees who are eligible for both Medicare and Tricare, offering secondary coverage to Medicare.
• TRICARE Reserve Select: A plan for members of the Selected Reserve who are not on active duty but still need affordable health coverage.
• TRICARE Retired Reserve: Provides health coverage for retired Reserve members under age 60 who are not yet eligible for Medicare.

What Are the Benefits of Tricare?

The benefits of Tricare insurance coverage are access to quality healthcare, affordability, and flexibility in choosing healthcare providers. Tricare provides a wide range of services, including preventive care, mental health services, addiction treatment, and prescription drug coverage, ensuring beneficiaries receive complete healthcare support. 

Common benefits of tricare insurance coverage include:

• Affordable Healthcare: Tricare offers low out-of-pocket costs for covered services, making healthcare more accessible to service members and their families. This includes affordable premiums, copayments, and no-cost preventive services. According to the Department of Defense, the average family pays significantly less than civilians for comparable healthcare coverage.
• Comprehensive Coverage: Tricare covers a wide range of healthcare services, including preventive care, emergency care, dental, mental health, and addiction treatment. These services ensure that beneficiaries have access to the care they need to maintain their health and well-being. Tricare also covers prescription medications, ensuring that individuals receive the drugs necessary for managing chronic conditions.
• Access to Military Treatment Facilities: Tricare provides access to military treatment facilities (MTFs), offering care at military hospitals and clinics. These facilities provide a range of services, including specialized care that are not be available in civilian networks. According to the Defense Health Agency, MTFs provide critical care to service members and their families, ensuring they receive high-quality treatment.
• Worldwide Coverage: Tricare offers global coverage for active-duty military members and their families, ensuring they access healthcare services while stationed abroad. Whether stationed in Europe, Asia, or other locations, Tricare’s overseas plans ensure that beneficiaries receive the same level of care as those within the U.S. The Department of Defense ensures Tricare’s international coverage for military personnel and their families stationed overseas.
• Mental Health Support: Tricare covers a variety of mental health services, including individual therapy, family therapy, and inpatient mental health care. Services such as Cognitive Behavioral Therapy (CBT) and medication management for conditions like depression and PTSD are included in Tricare’s mental health benefits. The National Institute of Mental Health (NIMH) reports that access to therapy and medication improves recovery outcomes, especially for military families.
• Preventive Care: Tricare includes coverage for preventive services like vaccinations, screenings, and health checkups, ensuring beneficiaries stay healthy. Preventive care reduces the risk of chronic diseases and allows for early detection and treatment of potential health problems. According to the Centers for Disease Control and Prevention (CDC), preventive services are essential in maintaining long-term health and reducing healthcare costs.
• Dental and Vision Coverage: Tricare includes dental and vision benefits, offering coverage for routine check-ups, fillings, eye exams, and glasses. This comprehensive coverage ensures that service members and their families have access to essential care for oral and eye health. Tricare’s dental plan is designed to help beneficiaries maintain optimal dental hygiene, reducing the risk of dental issues that affect overall health.
• Family Support: Tricare provides family-focused benefits, offering coverage for dependents and ensuring military families receive the care they need. This includes care for children, spouses, and dependent parents, which is essential for maintaining the health of the entire family unit. Tricare’s family support programs offer services to help families navigate the healthcare system and ensure they get the best care possible.

Does Tricare Cover all Costs?

No, Tricare does not cover all costs. While Tricare provides extensive healthcare coverage, beneficiaries are still responsible for certain out-of-pocket expenses, including co-pays, deductibles, and cost shares. 

The amount a beneficiary must pay depends on the specific plan they are enrolled in, as well as their military status and the type of care received. For example, active duty service members usually have minimal costs, while retirees or those using Tricare Select face higher out-of-pocket expenses for certain services. 

It’s essential for beneficiaries to understand their plan details and the potential costs that arise, as Tricare does not cover all treatments or non-medically necessary services.

How Can You Pay For Costs Not Covered by Tricare Insurance?

To pay for costs not covered by Tricare insurance, use health savings accounts (HSAs), flexible spending accounts (FSAs), or personal funds. Some beneficiaries also purchase supplemental insurance plans, such as Medigap or other private insurance, to help cover out-of-pocket costs. 

Additionally, for certain services, Tricare offers cost-sharing programs that reduce out-of-pocket expenses for beneficiaries. It’s important to explore all available options to ensure coverage for any gaps that exist in Tricare’s offerings.

What Are the Alternatives to Tricare? 

The alternatives to Tricare include VA healthcare, health insurance marketplace, and employer-sponsored health insurance. These other healthcare programs and insurance plans provide coverage for military personnel, retirees, and their families, as well as private insurance options. These alternatives offer different levels of coverage, cost-sharing, and access to healthcare providers, depending on the individual’s needs.

The alternatives to Tricare are as follows:

• VA Health Care: The Department of Veterans Affairs (VA) provides comprehensive healthcare services for veterans, including medical, dental, and mental health care. It is considered an alternative to Tricare for veterans who qualify.
• Health Insurance Marketplace: For those who do not qualify for Tricare, the Health Insurance Marketplace provides private insurance plans, which is suitable for military families or veterans who do not need comprehensive military healthcare.
• Employer-Sponsored Health Insurance: Some military retirees and their families qualify for employer-sponsored health insurance as an alternative to Tricare, especially if they or their spouses are employed in civilian jobs offering healthcare benefits.

Is Tricare the Same as Triwest?

No, Tricare is not the same as TriWest. While Triwest is a contractor that manages healthcare services for Tricare in certain regions, Tricare is the overarching health insurance program that provides coverage to military members, retirees, and their families. 

Triwest specifically administers Tricare benefits for beneficiaries in the Western U.S. and other areas, handling things like claims processing, provider networks, and customer service. The key difference is that TriWest is a third-party organization responsible for managing some of Tricare’s functions, whereas Tricare itself is the health insurance program offering benefits to eligible individuals.

Is Tricare the Same as Medicare?

No, Tricare is not the same as Medicare. Tricare is a health insurance program specifically for military service members, retirees, and their families, while Medicare is a federal health insurance program primarily for individuals aged 65 and older, or for those with certain disabilities. 

The main difference is that Tricare is available to active duty military personnel and their families, as well as veterans, whereas Medicare is available to the general public, regardless of military service. 

Additionally, Tricare provides more comprehensive healthcare services for military families, while Medicare focuses more on covering healthcare needs for seniors and eligible disabled individuals.

Is Tricare Available in California?

Yes, Tricare is available in California. Beneficiaries in the state can access Tricare West, which provides a wide range of healthcare services for military members and their families, ensuring they receive the care they need.

Is Tricare Available Internationally?

Yes, Tricare is available internationally. Active duty service members and their families, as well as certain retirees, access Tricare coverage in a variety of international locations, including Europe, the Middle East, and the Pacific. Tricare provides both direct care at military treatment facilities abroad and access to a network of civilian providers through its overseas plans, ensuring that military families stationed or living abroad have access to necessary healthcare services.

Do Treatment Centers in California Need to Be in the Tricare Network?

Yes, treatment centers in California needs to be in the Tricare network to ensure full coverage. Tricare operates through a network of authorized providers, and receiving care from an in-network facility results in lower out-of-pocket costs for beneficiaries. 

While Tricare does cover some out-of-network care under specific circumstances, such as emergencies, using in-network treatment centers helps ensure that the care provided is approved and reimbursed at a higher rate, making the process more affordable and streamlined for beneficiaries.

Is The LAOP Center Part Of The Tricare Network?

Yes, the LAOP Center, located in Culver City, CA 90230, is part of the Tricare network. As a certified provider, the LAOP Center offers services to eligible Tricare beneficiaries, including mental health treatment, addiction therapy, and other healthcare services.

Being part of the Tricare network allows the center to provide cost-effective care, ensuring that military personnel, retirees, and their families have access to quality treatment. Tricare beneficiaries receive these services with lower out-of-pocket expenses by utilizing the in-network benefits available through the LAOP Center in California. This inclusion is crucial in expanding the accessibility of healthcare services for those covered by Tricare.