TRICARE Residential Treatment Coverage & Costs 2026 | TRICARE.com

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## Quick answer TRICARE covers residential treatment for beneficiaries with mental health or substance use disorders that require 24/7 supervision but do not necessitate full inpatient hospitalization. Coverage is available for children, adolescents, and adults, provided the facility is TRICARE-certified and medical necessity is pre-authorized by your regional contractor (Humana Military or TriWest).

Details

Residential Treatment Centers (RTCs) provide a mid-level of care between intensive outpatient programs and acute inpatient psychiatric care. TRICARE split these benefits into two primary categories: **Residential Treatment Centers for Children and Adolescents** and **Substance Use Disorder Residential Treatment**.

### Coverage Requirements To be covered, the treatment must meet the following criteria: * **Medical Necessity:** A physician or qualified mental health provider must document that outpatient care is insufficient and 24-hour supervision is required. * **TRICARE-Certified Facility:** The facility must be authorized by TRICARE. Non-certified facilities will not be reimbursed, and retro-active certification is rarely granted. * **Pre-authorization:** You must obtain prior authorization before admission. For Active Duty Service Members (ADSMs), this must go through military medical channels or the regional contractor.

### Costs and Copays (2026 Rates) Costs depend on your beneficiary status and specific TRICARE plan:

* **Active Duty Service Members:** $0 out-of-pocket for all authorized residential care. * **Active Duty Family Members (ADFMs):** * **TRICARE Prime:** $0 copay. * **TRICARE Select:** Group A (enlisted before 2018) and Group B typically pay a per-diem rate. For 2026, the ADFM daily rate is approximately $20–$25 per day, though this is subject to the annual catastrophe cap. * **Retirees and their Families:** * **TRICARE Prime:** Typically a set copay (e.g., $30–$50 per day in 2026). * **TRICARE Select:** Usually 20% to 25% of the TRICARE-allowed amount after the deductible is met.

### Clinical Criteria The Defense Health Agency (DHA) mandates that residential care is not "custodial." This means the patient must be actively participating in a treatment plan aimed at improvement or stabilization. For substance use centers, TRICARE covers detoxification and rehabilitation, provided the facility provides 24-hour medical or nursing supervision.

### Regional Contractors * **East Region:** Managed by **Humana Military**. * **West Region:** Managed by **TriWest Healthcare Alliance** (effective 2025). * **Overseas:** Managed by **International SOS**. Note that residential treatment options overseas are extremely limited and often require medical evacuation (MedEvac) to a stateside facility.

## Who this affects * **Active Duty Service Members:** Full coverage, mandatory pre-authorization required. * **Active Duty Family Members:** Covered under Prime and Select. * **Retirees and their Families:** Covered; higher cost-shares apply. * **National Guard/Reserve:** Covered if enrolled in TRICARE Reserve Select (TRS). * **Survivors:** Covered under the same rules as retirees or ADFMs depending on status.

## Sources * **TRICARE.mil:** [Mental Health Care - Residential Treatment](https://www.tricare.mil/CoveredServices/IsItCovered/ResidentialTreatmentCenters) * **Humana Military (East):** [Mental Health & Substance Use FAQ](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West):** [Behavioral Health Services](https://www.triwest.com) * **TRICARE Manuals:** [DHA Policy on Residential Treatment](https://manuals.health.mil)