TRICARE Lowers Mental Health Care Co-Pays, Expands Treatment Options

This month retirees and dependents started paying $13 less per visit for outpatient care and substance abuse treatment.

The cost of mental health care coverage is going down for many TRICARE beneficiaries at the same time access to more treatment is expanding, according to the military health agency.

TRICARE retirees, as well as non-active duty dependents and survivors, generally will pay roughly half the co-payment for outpatient mental health care and substance abuse treatment – from $25 to $12 per visit – effective Oct. 3. “Co-pays and cost-shares for inpatient mental health services will also be the same as for inpatient medical/surgical care,” said a press release. If beneficiaries are overcharged by TRICARE providers unaware of the changes, TRICARE will correct those claims retroactive to Oct. 3.

Active-duty service members and their family members who have TRICARE Prime do not pay for their coverage. Click here for a list of mental health care costs by plan and beneficiary.

“Major changes are under way that will improve access to mental health and substance use disorder treatment for TRICARE beneficiaries, revise beneficiary cost-shares to align with cost-shares for medical and surgical care, and reduce administrative barriers to care by streamlining the requirements for institutional providers to become TRICARE authorized providers,” said Dr. John Davison, chief of the condition-based specialty care section of the Defense Health Agency’s Clinical Support Division. 

To encourage beneficiaries to take greater advantage of mental health treatment, TRICARE also has removed day limits associated with partial hospitalization, residential substance use disorder treatment, smoking cessation counseling and other mental health care treatment, effective Oct. 3. The length of treatment will be based “solely on medical and psychological necessity,” Davison said. Before the change, an individual struggling with alcoholism had a limit of three outpatient treatments under TRICARE. “The changes will allow people to seek help as many times as they need it,” the press release said. TRICARE also has expanded its treatment options for opioid addiction. 

As of Oct. 3, transgender beneficiaries can receive non-surgical treatment, which includes psychotherapy, pharmacotherapy and hormone treatment, under TRICARE. “Surgical care continues to be prohibited for all non-active duty beneficiaries,” said the press release.

“We are working as quickly as possible to implement these sweeping changes to the program over the next several months,” said Dr. Patricia Moseley, senior policy analyst for military child and family behavioral health at DHA.

Over the past few years, TRICARE has been working to expand mental health care treatment and coverage, and align its regulations more with industry standards. In 2014, TRICARE announced that enrollees in the military’s health care system can choose between independent TRICARE-certified mental health counselors (TCMHC) or supervised mental health counselors (SMHC).

The TRICARE-certified counselors are independent providers who can treat beneficiaries without a physician’s oversight as long as they have a master’s degree from a mental health counseling program accredited by the Council for Accreditation of Counseling and Related Education Programs, and pass the National Clinical Mental Health Counseling exam by Jan. 1, 2017. SMHCs provide care under the referral and supervision of TRICARE doctors.

The fiscal 2011 National Defense Authorization Act required Defense to develop criteria and guidance to allow licensed mental health counselors to provide and be paid for independent care to TRICARE beneficiaries to improve the quality of mental health care and standardize it. Before the change, enrollees only had access to SMHCs.

2010 report from the Government Accountability Office found that independent mental health providers were not familiar with TRICARE, and were more reluctant than physicians to accept TRICARE patients, in part because of a concern over reimbursement rates.