Mental health care for military families and dependents is a significant component of overall wellness, recognizing the unique stressors associated with service life. Tricare, the health care program for uniformed service members, retirees, and their families, offers comprehensive coverage for mental health services. Beneficiaries can access necessary behavioral health support to maintain their resilience and health. Securing a therapist involves understanding the scope of covered services and navigating the provider network. This guide streamlines access to care.
Understanding Mental Health Coverage
Tricare provides extensive coverage for medically necessary mental health and substance use disorder treatments. Covered services include outpatient psychotherapy, encompassing individual, family, and group therapy sessions. The program also covers medication management services provided by psychiatrists and other prescribing practitioners. Crisis intervention and emergency services are fully covered, allowing immediate access for mental health emergencies without prior authorization.
The financial structure for mental health care varies between Tricare Prime and Tricare Select plans. Tricare Prime, a managed care option, generally involves the lowest out-of-pocket costs, often resulting in minimal or no co-pays for in-network care. Tricare Select offers a self-managed, preferred provider network approach, granting greater flexibility in provider choice but typically involving higher out-of-pocket expenses through deductibles and cost-shares. Both plans cover the same essential behavioral health services, but beneficiaries should review their specific plan to understand their financial responsibility.
Navigating the Provider Search
The most direct way to locate a Tricare-authorized therapist is by utilizing the official Tricare Provider Directory tool available online. This resource allows beneficiaries to filter by specialty, such as behavioral health, and by geographic location. When searching, identify providers designated as “network” because they have a contractual agreement with Tricare to accept negotiated rates. Network providers are generally prohibited from balance billing beneficiaries for covered services, which results in the lowest cost-shares and protects against unexpected costs.
Tricare-authorized providers include a wide range of licensed professionals, ensuring diverse expertise is available for therapeutic needs. These professionals include:
- Psychiatrists
- Clinical psychologists (Ph.D. or Psy.D.)
- Licensed clinical social workers (LCSW)
- Licensed marriage and family therapists (LMFT)
- Licensed professional counselors (LPC)
While Tricare Select beneficiaries can see non-network providers, this results in higher out-of-pocket costs and may require the beneficiary to file their own claims. Regardless of the plan, beneficiaries should always contact the provider’s office directly before the initial appointment to confirm they are accepting new Tricare patients and verify their network status.
Required Authorizations and Documentation
Accessing specialty care, including mental health services, depends on the Tricare plan. Tricare Prime beneficiaries are typically enrolled with a Primary Care Manager (PCM) who coordinates all aspects of their care. While a referral from the PCM is generally required for specialty care, Tricare allows direct scheduling for most outpatient mental health visits to a network provider without a referral. Active duty service members, however, must still obtain a referral and pre-authorization from their PCM for civilian mental health care.
Prior authorization (PA) is a separate requirement where the regional contractor must approve certain services before they are rendered, regardless of the plan type. PA is generally not required for routine outpatient psychotherapy sessions, but it is necessary for more intensive treatments, including:
- Inpatient hospital stays
- Partial hospitalization programs (PHPs)
- Residential treatment center care
- Specific psychological testing
The provider is responsible for submitting the necessary documentation of medical necessity to the regional contractor to secure this authorization.
Specialized Resources and Telehealth Options
Beneficiaries have access to specialized military-centric resources that complement Tricare coverage. Military OneSource offers free, non-medical counseling services to service members and their families, providing support for stress, adjustment, and deployment-related issues without requiring a Tricare claim or referral. Military Treatment Facilities (MTFs) often house embedded behavioral health services, providing a convenient, no-cost option for care. Seeking non-emergency care at an MTF is typically prioritized for active duty service members.
Telehealth, or virtual therapy, is covered under Tricare, making it easier for families facing frequent moves or geographic isolation. Tricare covers telemental health services, including individual, family, and group psychotherapy, provided through secure video conferencing. The costs and referral requirements for virtual appointments are generally the same as for in-person care, depending on the beneficiary’s Tricare plan. Several specialized telehealth platforms are integrated with Tricare, offering a streamlined way to connect with a licensed practitioner.