TRICARE rolled out several improvements to its mental health and substance use disorder benefits effective October 3.
Beginning Oct. 3, 2016, non-active duty dependent beneficiaries, retirees, their family members and survivors will generally pay lower co-payments and cost-shares for mental health care, such as $12 for outpatient mental health and substance use disorder visits rather than the current rate of $25 per mental health visit. Co-pays and cost-shares for inpatient mental health services will also be the same as for inpatient medical/surgical care.
TRICARE will correct any claims that were overcharged retroactive to Oct. 3, 2016.
TRICARE has already eliminated restrictions on the lengths of stay allowed for inpatient mental health treatment and psychiatric residential treatment care for children and adolescents. Additional day limits for services such as partial hospitalization, residential substance use disorder care, smoking cessation counseling, and other mental health treatment were removed on October 3. TRICARE says the removal of these limits altogether will further de-stigmatize mental health treatment and hopefully provide a greater incentive for beneficiaries to seek the care they need. Unlike many private insurance plans, mental health treatment under TRICARE will be based solely on medical and psychological necessity.
For example, a person struggling with alcoholism previously was limited to three outpatient treatments in their lifetime, the new TRICARE benefit will now allow people to seek help as many times as they need it.
TRICARE is also expanding its coverage of treatment options for substance use disorders, including opioid use disorder, which can range from addiction to heroin to prescription drugs. This change will provide more treatment options, such as outpatient counseling and intensive outpatient programs. Office visits with a qualified TRICARE authorized physician may include coverage of medication-assisted treatment (e.g., buprenorphine, or “suboxone”) for opioid addiction if the physician is certified to prescribe these medications.
Gender dysphoria – a condition in which a person experiences distress over the fact that their gender identity conflicts with their sex assigned at birth – may be treated non-surgically by TRICARE-authorized providers effective Oct. 3. Non-surgical treatment includes psychotherapy, drug, and hormone treatment. Surgical care continues to be prohibited for all non-active duty beneficiaries.
