TRICARE Behavioral Health Services: Coverage & Costs Guide

## Quick answer TRICARE covers a wide range of behavioral health services, including outpatient therapy, inpatient psychiatric care, and substance use disorder treatment. For most active-duty family members and retirees, you can see an in-network mental health provider for outpatient office visits without a referral, though Active Duty Service Members (ADSMs) always require a referral and prior authorization.

## In detail TRICARE’s behavioral health coverage is designed to provide comprehensive support for mental health and substance use. Services are generally divided into outpatient care, intermediate care, and inpatient care.

*Note: TRICARE.Com is an independent reference site and is not the official TRICARE program. For official policy and the most current data, visit TRICARE.mil.*

### Types of Covered Care * **Outpatient Therapy:** Individual, family, and group therapy sessions with licensed providers (Psychologists, Clinical Social Workers, Mental Health Counselors). * **Psychiatric Services:** Medication management and diagnostic evaluations performed by board-certified psychiatrists or psychiatric nurse practitioners. * **Intermediate Care:** Includes Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) for those needing more than weekly therapy but not 24/7 hospitalization. * **Inpatient Care:** Emergency and non-emergency psychiatric hospitalization and Residential Treatment Centers (RTC) for children and adolescents. * **Substance Use Disorder (SUD) Treatment:** Detoxification, rehabilitation, and medication-assisted treatment (MAT).

### Referral and Authorization Requirements The rules for "how" you access care depend on your plan:

*Note: While a referral may not be needed, "Prior Authorization" is still required for certain services like Applied Behavior Analysis (ABA), TBI care, or non-emergency inpatient admissions.*

### 2026 Costs and Copayments (Estimated) Costs vary based on your "Group" (Group A joined before 2018; Group B joined after) and status. * **Active Duty Service Members:** $0 for all authorized care. * **Active Duty Family Members (Prime):** $0 for outpatient visits with network providers. * **Retirees (Prime):** Approximately $38 per outpatient visit (2026 rate). * **TRICARE Select (Retirees):** Approximately $35–$55 per visit, depending on Group status and provider network standing.

### Regional Contractors As of 2026, TRICARE is managed regionally: * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance (T-5 Contract) * **Overseas:** International SOS

## Who this applies to * **Active Duty Service Members:** Must seek care through Military Treatment Facilities (MTFs) first; civilian care requires a formal referral and authorization from their PCM. * **Active Duty Family Members:** Have the most flexibility to use "Point of Service" or network providers without a PCM referral for outpatient therapy. * **Retirees and their Families:** Subject to copayments; can choose any TRICARE-authorized provider, but costs are significantly lower when using network providers. * **National Guard and Reserve:** Coverage applies when on active duty orders or if enrolled in TRICARE Reserve Select (TRS).

Common scenarios

**Scenario 1: The Spouse on TRICARE Prime** Jane is an active-duty spouse in Virginia (East Region). She wants to see a therapist for anxiety. Because she is on Prime, she does **not** need a referral from her doctor. She finds an in-network therapist using the Humana Military provider directory. Her 2026 copay is **$0**.

**Scenario 2: The Retiree on TRICARE Select** Mark is a retiree living in Arizona (West Region). He sees a private psychologist for PTSD. Because he is on TRICARE Select (Group A), he does not need a referral. He sees a network provider. In 2026, he pays a **$35 copay** per session after meeting his annual deductible.

**Scenario 3: Emergency Inpatient Care** An adolescent dependent requires emergency psychiatric hospitalization. The family goes to the nearest ER. TRICARE covers emergency admissions without prior authorization, but the facility must notify the regional contractor (TriWest or Humana) within **24 to 72 hours** of admission to ensure continued coverage.

## Related terms * **Telemental Health:** Secure video conferencing for therapy and psychiatry, covered with the same cost-shares as in-person visits. * **Non-Authorized Provider:** A provider who has not met TRICARE’s licensing or certification requirements; TRICARE will not pay for services from these providers. * **Residential Treatment Center (RTC):** A live-in facility providing 24/7 care for children and adolescents under age 21. * **Point of Service (POS) Option:** An expensive "out-of-network" gateway where Prime beneficiaries see unauthorized providers, resulting in higher deductibles and 50% cost-shares.

## Sources * TRICARE.mil Mental Health Care Overview: https://www.tricare.mil/mentalhealth * Humana Military (East): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West): https://www.triwest.com/ * Defense Health Agency (DHA): https://health.mil/