Is TRICARE private insurance? No. It is a government health care program run by the Department of Defense for uniformed service members, retirees and their families. TRICARE does use civilian doctors and treatment programs, which is why it often feels like private coverage. It also covers mental health care, including intensive outpatient and partial hospitalization programs. Substance use treatment is covered too.
Key Takeaways
- TRICARE is a public, government-run health program, not a private insurance company.
- It covers active duty members, Guard or Reserve members, retirees and their families.
- TRICARE covers outpatient therapy, IOP, PHP and medication-assisted treatment.
- IOP and PHP need a referral or pre-authorization before you start.
- Active duty members usually start at a military clinic before getting a civilian referral.
- TRICARE Select members can see any TRICARE-authorized provider, but network providers cost less.
Is TRICARE Private Insurance or Public?
TRICARE is public coverage. It is the health care program of the Military Health System, administered by the Defense Health Agency. Unlike private insurance, you don’t buy it from a company. Eligibility comes from your military status or your sponsor’s status.
TRICARE describes itself as a health care program, not an agency, on its eligibility page. Your sponsor’s branch of service decides who qualifies and records it in the Defense Enrollment Eligibility Reporting System (DEERS).
The confusion is understandable. TRICARE works with civilian hospitals, therapists and treatment centers through regional contractors. Your care may look a lot like care under a private plan, even though the program is government-funded.
Who Is Eligible for TRICARE?
- Active duty service members and their families
- National Guard and Reserve members, depending on their status
- Military retirees and their families
- Survivors and certain former spouses
- Medal of Honor recipients and their families
Veterans who served but did not retire from the military usually get care through the VA instead of TRICARE. The two are separate programs.
TRICARE vs Private Insurance
| Feature | TRICARE | Private insurance |
|---|---|---|
| Who runs it | Department of Defense | An insurance company |
| How you get it | Military service or a sponsor’s service | An employer, the marketplace or a direct purchase |
| Where you get care | Military clinics or TRICARE-authorized civilian providers | The plan’s network |
| Cost | Low or no premiums for many members | Varies by plan |
Does TRICARE Cover Mental Health Treatment?
Yes. According to the TRICARE mental health fact sheet, covered outpatient care includes:
- Psychotherapy: individual, family and group sessions for a covered diagnosis.
- Intensive outpatient program (IOP): about 6 to 9 or more hours of treatment a week.
- Partial hospitalization program (PHP): more than 9 hours of treatment a week.
- Telemental health: video or audio visits under the same rules as in-person care.
These levels of care treat conditions common in military families, such as depression, anxiety, trauma and PTSD.
Does TRICARE Cover Rehab?
Yes. TRICARE’s substance use disorder coverage includes intensive outpatient programs, partial hospitalization and medication-assisted treatment. It also covers withdrawal management and therapy services.
Coverage depends on medical need, your plan and whether the provider is TRICARE-authorized. Some services have special rules or limits.
Referrals and Pre-Authorization Rules
Active Duty Service Members
Active duty members should seek nonemergency mental health care at a military hospital or clinic first. If care isn’t available there, your primary care manager can refer you to a civilian provider. Get the referral before you start outside treatment.
Family Members and Retirees
Most outpatient therapy visits don’t need pre-authorization. IOP and PHP do require a referral or pre-authorization. TRICARE Prime members usually need a referral to see a non-network provider. TRICARE Select members can see any authorized provider, but pay less in network.
Always confirm the rules for your plan before your first visit. A treatment center’s admissions team can check your benefits with you.
Conclusion
TRICARE is not private insurance. It is a government health program for service members, retirees and their families. It covers a wide range of mental health care, from weekly therapy to IOP or PHP. Substance use treatment is included.
The key is following the referral and pre-authorization steps for your plan. Once those are in place, TRICARE can make outpatient treatment affordable.
Outpatient Care for Service Members and Veterans at Lotus Recovery
Lotus Recovery Treatment Center runs a dedicated veterans and active duty military program in Thousand Oaks. We treat PTSD, depression, anxiety, drinking and drug use with care that understands military life.
You can attend our intensive outpatient program or PHP, with an evening option for people who work. Doctors are on call 24/7.
Call (805) 856-6690 or verify your insurance to check your coverage and book a same day appointment.
Frequently Asked Questions
What type of insurance is TRICARE?
TRICARE is a government health care program for the uniformed services. It is managed by the Defense Health Agency within the Department of Defense. It offers several plans, such as TRICARE Prime or TRICARE Select. Each has its own rules for referrals and costs.
Is TRICARE Medicaid or Medicare?
No. TRICARE is separate from both. Medicaid is a state and federal program based on income. Medicare is federal coverage mainly for people 65 and older. Some military retirees have both Medicare and TRICARE For Life, which works alongside Medicare.
Is TRICARE a public insurance?
Yes. TRICARE is public, government-funded coverage. You can’t buy it from a private company. Eligibility depends on military service, either your own or your sponsor’s.
Does TRICARE cover therapy?
Yes. TRICARE covers individual, family and group psychotherapy for covered diagnoses from TRICARE-authorized providers. Marriage counseling is not covered. Active duty members need to follow referral rules before seeing a civilian therapist.
Does TRICARE cover IOP and PHP?
Yes, for both mental health and substance use. Both programs require a referral or pre-authorization. Prime members going to non-network programs usually need a referral from their primary care manager to avoid higher costs.
