Behavioral Health: TRICARE Definition and Coverage | TRICARE.com

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## Definition Behavioral health refers to the spectrum of medical services used to treat mental health conditions (such as depression or PTSD) and substance use disorders.

## What it means in practice For TRICARE beneficiaries, behavioral health coverage is comprehensive and includes outpatient therapy, inpatient psychiatric care, and detoxification programs. Under current 2026 guidelines, TRICARE classifies most behavioral health services as "proven medical care," meaning you do not always need a referral for outpatient sessions if you are using a TRICARE-authorized network provider. However, Active Duty Service Members (ADSMs) still require a referral and prior authorization for all mental health care outside of a military clinic.

The cost of these services depends on your plan and the setting. For example, in 2026, a retiree on TRICARE Select might pay a fixed copayment for an outpatient group therapy session (typically around $30–$35 at a network provider), while those on TRICARE Prime generally have a $0 copay for authorized network care. If you require higher levels of care, such as Partial Hospitalization Programs (PHP) or Residential Treatment Centers (RTC), TRICARE covers these as long as they are medically necessary and provided by an authorized facility.

The management of these benefits depends on your location. If you are in the **East Region**, your care is managed by **Humana Military**. In the **West Region**, as of the T-5 contract transition on January 1, 2025, your care is managed by **TriWest Healthcare Alliance**. For medications related to behavioral health, such as antidepressants or anti-anxiety meds, the benefit is managed by **Express Scripts** via the TRICARE Pharmacy Program.

## Related terms * **Telemental Health:** The delivery of behavioral health services via secure video conferencing, covered by TRICARE with the same cost-shares as in-person visits. * **Medically Necessary:** A standard used by TRICARE to determine if a behavioral health treatment is appropriate, reasonable, and required to treat your condition. * **Prior Authorization:** A requirement where your regional contractor (Humana or TriWest) must approve a specific treatment, like intensive outpatient programs, before you receive care. * **Substance Use Disorder (SUD):** A specific category of behavioral health involving the clinical treatment of alcohol or drug addiction. * **Point-of-Service (POS) Option:** An additional cost incurred by Prime beneficiaries who see a behavioral health provider without a required referral.

## Sources * TRICARE Mental Health Care Overview: [https://www.tricare.mil/MentalHealth](https://www.tricare.mil/MentalHealth) * TriWest Healthcare Alliance (West Region): [https://www.triwest.com](https://www.triwest.com) * Humana Military (East Region): [https://www.humanamilitary.com](https://www.humanamilitary.com)