Overview of TRICARE
TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services, is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for Uniformed Service members and their families, National Guard/ Reserve members and their families, survivors, former spouses, medal of honor recipients and their families, and others registered under DEERS (Defense Enrollment Eligibility Reporting System). You must be registered in the DEERS to be eligible for TRICARE. Sponsors are automatically registered in DEERS and sponsors must register eligible family members. If both parents are service members, choose one to be listed as the children’s sponsor in DEERS.
TRICARE is the civilian care component of the Military Health System, although historically it also included health care delivered in the military medical treatment facilities.
TRICARE covers health care, dental care, mental health care, pharmacy, special needs and vision care.
Non-Emergency Mental Health Care
It is not necessary to get a referral or prior authorization for any outpatient mental health (except psychoanalysis) and substance use disorder (SUD) care. This includes services like therapy and counseling. If an individual chooses a provider outside the network, they may pay higher costs.
For psychoanalysis or care from an institutional provider outside of a military hospital or clinic, a referral for non-emergency mental health and SUD care is needed. TRICARE makes a note to all that use this insurance for mental health care needs stating
“We don’t want to discourage you from getting help. We want to make sure your condition doesn’t negatively affect your health and ability to perform your duties.”
Benefits and plans will vary depending on the beneficiary category the individual falls under:
If you.... then...
Are an active duty service member.... You need to get a referral and prior authorization for all mental health care.
Are a non-active duty TRICARE Prime beneficiary.... You need to get a referral and prior authorization for psychoanalysis and outpatient therapy for substance use disorder provided by a substance use disorder rehabilitation facility.
Use TRICARE For Life....Medicare is the primary payer for mental health care. You only need a referral or authorization from TRICARE if your Medicare benefits are exhausted.
Use any other TRICARE health plan.... You need to get a referral and authorization for psychoanalysis and outpatient therapy for substance use disorder provided by a substance use disorder rehabilitation facility.