Substance Use Disorder | TRICARE Coverage & Costs | TRICARE.com

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## Definition Substance Use Disorder (SUD) is a clinical diagnosis for the uncontrollable use of alcohol or drugs despite negative consequences, which TRICARE covers through a variety of inpatient and outpatient treatment programs.

## What it means in practice For TRICARE beneficiaries, a diagnosis of Substance Use Disorder triggers access to a comprehensive "continuum of care." This means the military health system provides coverage for everything from emergency detoxification to long-term outpatient counseling. Unlike some private insurers, TRICARE does not require a physician referral for office-based outpatient SUD treatment, although active duty service members (ADSMs) must always coordinate through their military hospital or clinic and commander.

Coverage includes Medical Detoxification (hospitalization to safely manage withdrawal), Inpatient Rehabilitation (24/7 care for critical stabilization), and Intensive Outpatient Programs (IOP). Under the current T-5 contract managed by Humana Military (East) and TriWest Healthcare Alliance (West), beneficiaries can also access Opioid Treatment Programs (OTPs) and Office-Based Opioid Treatment (OBOT).

The costs for SUD treatment depend on your plan and beneficiary category. For example, in 2026, TRICARE Select Group A retirees might pay a 25% cost-share for in-network outpatient SUD sessions, while TRICARE Prime active duty family members typically have a $0 copayment for covered services from network providers. Residential Treatment Centers (RTCs) for SUD are covered for both adults and children, provided the facility is TRICARE-certified.

All SUD prescriptions, such as buprenorphine or naltrexone, are managed through Express Scripts. While TRICARE covers the clinical aspects of recovery, it specifically excludes "aversion therapy" or treatments not medically validated by the Defense Health Agency.

## Related terms * **Medical Detoxification:** Inpatient medical care to manage the physical symptoms of withdrawal from alcohol or drugs. * **Intensive Outpatient Program (IOP):** A structured treatment program that provides more hours of care per week than standard outpatient therapy but does not require an overnight stay. * **Residential Treatment Center (RTC):** A live-in facility where patients receive supervised, highly structured care for mental health or substance use issues. * **Partial Hospitalization Program (PHP):** A day-treatment format where patients spend 6+ hours at a facility daily but return home at night. * **Cost-Share:** The percentage of the total cost of a covered health care service that a beneficiary pays after the deductible is met.

## Sources * TRICARE.mil - Mental Health and Substance Use Disorder: https://www.tricare.mil/CoveredServices/IsItCovered/SubstanceUseDisorderTreatment * Defense Health Agency - Behavioral Health Coverage: https://health.mil/Military-Health-Topics/Centers-of-Excellence/Psychological-Health-Center-of-Excellence * Humana Military (TRICARE East) SUD Resources: https://www.humanamilitary.com/beneficiary/health-and-wellness/behavioral-health/adhd-sud/substance-use-disorder