The military community, including active-duty service members, retirees, and their families, often requires accessible mental healthcare. Tricare, the healthcare program for this community, covers a wide range of mental and behavioral health services. Finding a therapist who accepts Tricare can be complex due to varying plan types and provider networks. This guide clarifies the process and provides practical steps for beneficiaries seeking covered therapy services.
Understanding Tricare Mental Health Coverage
Tricare provides extensive coverage for mental and behavioral health treatments, recognizing the importance of these services to overall well-being. Federal requirements mandate parity, meaning access and financial requirements for mental health services must be comparable to those for physical healthcare.
The covered services span the full continuum of care, from outpatient therapy to intensive treatment programs. Individual, group, and family therapy sessions are covered when provided by Tricare-authorized professionals. Additionally, coverage extends to substance use disorder treatment, including both detoxification and rehabilitation services.
Higher levels of care, such as Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP), are also included in the benefit structure. Inpatient hospitalization for mental health is covered, ensuring beneficiaries can seek help for a variety of conditions, including depression, anxiety, post-traumatic stress, and adjustment disorders.
Navigating Provider Networks and Authorization
The path to securing mental health care under Tricare depends heavily on a beneficiary’s specific plan, primarily the distinction between Tricare Prime and Tricare Select. Tricare Prime is a managed care option offering lower out-of-pocket costs but requiring the use of a Primary Care Manager (PCM). Tricare Select, a self-managed preferred provider network plan, offers more flexibility in choosing providers.
For routine outpatient mental health care, most Tricare Prime beneficiaries do not need a referral to see a network psychiatrist or psychologist. However, active-duty service members must generally obtain a referral for all care not provided by their PCM. If a Prime beneficiary chooses to see a non-network provider without a referral, they will incur higher costs under the point-of-service option.
Tricare Select beneficiaries have direct access to any Tricare-authorized provider, meaning a referral is usually not required for outpatient mental health services. Although Select offers greater choice, beneficiaries save money by seeing a Tricare network provider. For both Prime and Select, pre-authorization is required for certain specialized services, such as psychoanalysis, and for all inpatient mental health care.
To begin the search, beneficiaries should use the official provider search tools provided by regional Tricare contractors, such as Humana Military or Health Net Federal Services. These online directories allow users to filter by specialty, location, and plan type to identify in-network providers who are accepting new patients. Using a network provider is the most direct way to minimize out-of-pocket expenses and avoid the administrative burden of filing claims.
When considering non-network providers, beneficiaries must understand the financial implications. Non-network providers are Tricare-authorized but have not signed a contract agreeing to the negotiated rate. There are two types of non-network providers: participating providers, who accept the Tricare-allowable charge as payment in full, and non-participating providers. Non-participating providers can bill the beneficiary up to 15% above the Tricare-allowable charge, resulting in higher personal costs and potential balance billing.
Types of Licensed Mental Health Professionals Covered
Tricare authorizes and reimburses a variety of licensed mental health professionals, ensuring a diverse range of expertise is available for patient care. Understanding the different credentials helps beneficiaries select a provider whose training aligns with their needs.
Psychiatrists (MD or DO) are medical doctors specializing in mental health. They focus on diagnosis, medication management, and psychotherapy, and are the only providers authorized to prescribe medication.
Clinical Psychologists (Ph.D. or Psy.D.) hold doctoral degrees and provide psychological testing, diagnosis, and a wide array of psychotherapy services. They often specialize in advanced treatment modalities like trauma-focused therapies. These professionals generally do not prescribe medication but often work collaboratively with a psychiatrist or PCM for medication needs.
Master’s-level therapists recognized for independent practice include:
- Licensed Clinical Social Workers (LCSW), who provide psychotherapy and focus on the interaction between a person and their environment.
- Licensed Marriage and Family Therapists (LMFT), who specialize in relationship dynamics and offer individual, couple, and family counseling.
- Licensed Professional Counselors (LPC) or Licensed Mental Health Counselors (LMHC), who provide a broad spectrum of individual and group counseling services.
Tricare also covers Certified Psychiatric Nurse Specialists and Certified Clinical Nurse Specialists. These specialists provide psychotherapy and, in some states, may also manage prescriptions.
Costs and Financial Considerations
Financial responsibility for therapy involves deductibles, copayments, and cost-shares, which vary based on the beneficiary’s plan and status. Tricare Prime typically has the lowest out-of-pocket costs, often requiring a zero dollar copayment for in-network outpatient mental health visits for active-duty family members. Retirees enrolled in Prime usually pay a modest copay per visit.
Tricare Select beneficiaries must meet an annual deductible before cost-sharing begins. Once the deductible is met, Select users pay a percentage of the Tricare-allowable charge, known as a cost-share. This cost-share is lower for network providers. Using a non-network, non-participating provider results in the highest out-of-pocket costs, as the beneficiary pays the cost-share plus the potential 15% balance bill.
All eligible out-of-pocket costs, including deductibles, copayments, and cost-shares for covered services, count toward the family catastrophic cap. This cap is the annual maximum amount a family pays for covered healthcare services in a calendar year. Once this limit is reached, Tricare pays 100% of the allowable charge for all remaining covered care. Costs that do not count toward the cap include annual enrollment fees and fees incurred using the Prime point-of-service option.