Military and veteran coverage
Using TRICARE or VA Community Care for addiction and mental health treatment
TRICARE and VA Community Care can both help pay for substance use and mental health treatment, but each has its own approval steps. This guide explains how referrals and authorizations work and what to ask before care starts.
6 min read. Clinical review pending.
Two programs, two sets of rules
TRICARE is the health care program for uniformed service members, retirees and their families. VA Community Care is different. It is how the Department of Veterans Affairs (VA) pays for your care from a provider in its community care network, when VA approves it.
Each program has rules about whether you need a referral, whether care must be approved first, and which providers you can see. Knowing the steps ahead of time can help you avoid delays and surprise bills.
This guide is general information from TRICARE and VA sources. Your own plan, region and eligibility decide what applies to you.
What TRICARE may cover for substance use care
TRICARE says it may cover:
- Inpatient services, both emergency and non-emergency
- Management of withdrawal symptoms (detox)
- Partial hospitalization programs (PHP)
- Intensive outpatient programs (IOP)
- Medication-assisted treatment, office-based opioid treatment and opioid treatment programs
- Mental health therapy services
What TRICARE does not cover
TRICARE covers services that are medically necessary and considered proven. It does not cover aversion therapy or unproven treatments. Some services have special rules or limits, so ask before a service starts.
Since December 2014, TRICARE has had no yearly day limits on inpatient and residential substance use care. Each stay still has to be medically necessary.
Referrals and preauthorization: what is the difference?
A referral is when your primary care manager (PCM) or provider sends you to another provider for care they do not provide. A preauthorization is when your regional contractor approves your care before you go. If you are being referred, your provider gets the referral and preauthorization at the same time.
Your regional contractor depends on where you live. In the TRICARE East Region it is Humana Military. In the West Region it is TriWest Healthcare Alliance.
When care is approved, your regional contractor sends you an authorization letter. Book your care with the provider named in the letter, and get care before the authorization expires. If it expires, the care has to be approved again.
TRICARE rules for substance use treatment
| Situation | Referral needed? | Preauthorization needed? |
|---|---|---|
| Non-emergency inpatient or residential care | TRICARE Prime: yes, from your PCM. TRICARE Select: no. | Yes. |
| PHP or IOP with TRICARE Prime | Yes, from your PCM, unless a network provider asks for preauthorization instead. | Not required by the TRICARE Policy Manual, but check with your regional contractor. |
| PHP or IOP with TRICARE Select | No. | Not required by the TRICARE Policy Manual, but check with your regional contractor. |
| Active duty service members | Yes, for care in the TRICARE network. | Yes, for care in the TRICARE network. |
| Mental health emergency | No. | No. If you are admitted, call your PCM or regional contractor within one day or by the next business day. |
How VA Community Care works
With VA Community Care, VA pays for your care from a provider in its community care network. To use it, you must be enrolled in or eligible for VA health care. Your VA health care team must also approve the care before you get it, except in certain cases such as urgent or emergency care.
You must also meet at least one eligibility condition. For example, VA does not offer the service you need. Or VA cannot offer you mental health care within a 30-minute average drive or a 20-day wait. Or you and your VA provider agree that community care is the right medical choice for you.
You can always choose to get care at a VA facility instead. If VA denies your request for community care, you can appeal through VA's clinical appeals process.
As with care from VA directly, you may be charged a copayment for care that is not connected to your military service.
Getting a VA Community Care referral, step by step
This is the process VA describes for care from an in-network community provider:
Step 1
Find an in-network provider
Search for a community provider yourself, or ask your VA health care team to find one for you.
Step 2
Ask your VA team for a referral
VA reviews your request to make sure you are eligible, confirms the type of care you need, and prepares the referral. VA says this part can take up to 14 days.
Step 3
Schedule your appointment
Schedule it yourself or ask your VA team to do it. If you schedule it yourself, tell your VA team within 14 days.
Step 4
Get your authorization letter
This letter is your approval. It lists an authorization number, your approved provider, the care you can get, and how long you can get care before you need a new referral.
Step 5
Keep track of your care
VA will not cover services your authorization letter does not include. If you need more care, you or your provider can ask for a new referral.
How this works at FHE Health
True Again Care is a program of FHE Health in Deerfield Beach, Florida. FHE Health is a TRICARE-contracted treatment center that works with TRICARE East, Select and Prime. Its admissions team can check your TRICARE benefits before care starts.
TRICARE may not cover every service FHE Health offers, such as some wellness services. Ask the admissions team which parts of your care are covered.
FHE Health is also a credentialed VA Community Care Network provider for mental health and substance use care. VA Community Care always starts with the VA, and you cannot self-refer. Talk with your VA health care team first, and ask whether a referral to FHE Health is an option for you.
See insurance and TRICARE for other ways to pay, and our veterans and military page for more about care for service members and veterans.
Questions to ask about TRICARE
- Which TRICARE plan and region am I in?
- Do I need a referral from my PCM for this level of care?
- Does this care need preauthorization, and who will ask for it?
- Is this provider in the TRICARE network, and what will I pay?
- When does my authorization end, and how is more care approved?
- Are any services in this program not covered?
Questions to ask your VA health care team
- Am I eligible for community care for this type of care?
- Can you send a referral to the provider I chose?
- What will my authorization letter cover, and for how long?
- Will I owe a copayment?
- What happens if I need more care, or a different level of care?
- How do I appeal if my request is denied?
Questions about TRICARE or a VA referral?
Call (833) 596-3502 to talk with FHE Health's admissions team. They can check your TRICARE benefits and explain how VA Community Care works with FHE Health. For VA care, start with your VA health care team.
Sources
- TRICARE: About us
- TRICARE: Substance Use Disorder Treatment
- TRICARE: Referrals and Pre-Authorizations
- TRICARE: Emergency and Nonemergency Mental Health Care
- TRICARE Policy Manual, Chapter 7, Section 3.5: Substance Use Disorders
- VA: Eligibility for community care outside VA
- VA: How to get community care referrals and schedule appointments
- VA: Community Care, Veteran Care Overview
- Health.mil: Military Command Exception
- DoD Instruction 6490.08: Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members (2023)
- VA: Veterans Crisis Line