Within the military community, TRICARE is known for the health coverage for active-duty families and their dependents. It is the constant coverage for medical and mental health benefits.
When a service member retires, does that coverage change? If the service member retired with benefits and retains TRICARE coverage, then TRICARE covers the retiree and their dependents.
Before the age of 65
When service members retire with benefits, there are several eligible health care plans to choose from. TRICARE Prime, TRICARE Select, US Family Health Plan (depending on locations), TRICARE for Life and TRICARE Select Overseas are options, depending on the location of the service member and other eligibilities. For example, a retired service member is only eligible for TRICARE for Life before the age of 65 if they are eligible for TRICARE and they have both Medicare Part A and B. Most military retirees utilize TRICARE Prime, meaning they are near a military base that they are able to receive medical care at, or TRICARE Select, meaning they are using TRICARE to be seen by civilian providers whether they are near a military base or not.
What is covered?
Mental Health coverage for retirees under the age of 65 is similar to those on active-duty service utilizing TRICARE for coverage. What is covered by TRICARE’s plans is covered here. This includes rehabilitation therapy, family therapy, intensive outpatient programs, and partial hospitalization therapy. This does not mean that there are no out-of-pocket charges for these treatments. On the whole, there is a contracted rate with in-network providers that accept the rate that TRICARE will reimburse for this.
What isn’t covered?
There are several exclusions for what TRICARE does not cover. Notably, counseling services like nutritional counseling, stress management, and marital therapy are not covered by TRICARE. For active duty service members, there are other resources that can be utilized to provide these services if needed. The full list of what is not covered is listed here.
What if the services needed are not covered?
If marital therapy is needed and it is not covered by TRICARE, a referral to family therapy from the primary care provider may help get this covered. Family therapy is a covered benefit when it is used for the benefit of the individual’s mental health. Other ways of receiving marital counseling may be available through a place of worship. Non-denominational churches may offer affordable counseling services. Veteran’s Affairs hospitals and clinics often have a chaplain on staff or within their network that they can refer to as well for counseling.
What about over the age of 65?
Once Medicare-eligible individuals read the age of 65 and are entitled to Medicare, the beneficiaries are automatically enrolled in TRICARE for Life. This means Medicare becomes the primary payer for medical costs. TRICARE will become the secondary payer, or the last if the beneficiary carries another health care insurance.
What does this mean for mental health coverage?
For beneficiaries with TRICARE for Life coverage, Medicare becomes the primary payer. This means that Medicare helps pay for and cover the following:
- Depression screening by a provider
- Psychiatric Evaluation
- Individual and group psychotherapy
- Family counseling, if the main purpose of treatment is for the individual
- Medication Management
Whatever costs Medicare doesn’t cover, can be billed to TRICARE. Traditionally TRICARE covers mental health services that are medically required that include:
- Psychotherapy, to include individual, group, and family/joint sessions
- Psychological Testing
- Medication-assisted treatment
What is NOT covered by Medicare or TRICARE in regards to mental health coverage
- Art Therapy
- Music Therapy
- Dance Therapy
- Occupational Therapy
The only time these therapies would be covered is if they are part of a medically required inpatient, partial hospitalization, or intensive outpatient program which are covered.
What are the costs?
Of the services listed above, the only 100% covered service with no cost to the individual is the annual depression screening by a provider. For every other service, the individual pays 20% of the Medicare-approved amount. This copay can be submitted to TRICARE for Life for coverage, and they may reimburse for that cost.
Don’t Forget Telehealth
Tricare has partnered with Telemynd for online counseling and mental health services. This telehealth partner covers all TRICARE eligible beneficiaries for services without copays or co-shares. Telemynd does not require a referral or authorization as of this writing. They can provide counseling for grief, stress, work, family issues in addition to depression and anxiety.
While it isn’t always easy to understand where to go for services, there are some covered services available for retirees. Always ask your primary care provider for options and services too as they know your local area. Mental health is part of your physical health.