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.
does tricare for life pay for trainsporten to and from appointments
this is nice to know, i have found that these services were never explain to our military families, i feel that it is a failure to know this information after the fact and that communication is an important factor for all.
Please treat all our military families the same including our retirees.
What a shame, and a little too late.
I filed with MEDICARE for the cost of 2 PRCC tests required for international travel. It took a year plus for finally pay me $90 for $440 I paid “out of pocket”. Can I file with Trieste for Life for the remaining amount I paid? During this timeframe most primary care providers could not provide overnight testing needed for international travel. My primary care doctor directed me to a outside PRC testing site that provided this service and I had to pay for it and file with insurance afterwards.
Dose Tricare cover any cost for treatment of Dementia/Alzheimer?
Tricare should cover medical treatment as recommended by your provider, with any required co-pays per your plan.
Great explanation of the mental health access/coverage for military retirees. Being a military retiree from serving in the USMC and US Air Force and USAF Civil service. My wife and I are in our 80’s and have been very thankful for TRICARE benefits.
Thank you for keeping us informed. We appreciate your outstanding work.
I am a retired US Air Force Chief Master Sergeant (E-9) with over 30-years on active duty. I have so many promises broken and benefits taken away, and it’s not about to stop.
For so long I’ve heard Congress say the military and the service members need to do more with less; that it has now become a sick joke. “We Have Done So Much with So Little for So Long, that Now We Can Do Anything with Nothing.”
On November 13th, 1789, Benjamin Franklin wrote in a letter to Jean-Baptiste Leroy a phrase that has reverberated ever since: “Our new Constitution is now established, and has an appearance that promises permanency; but in this world nothing can be said to be certain, except death and taxes.”
In the 1867 inaugural address at the University of St. Andrews, philosopher John Stuart Mill stated: “Let not any one pacify his conscience by the delusion that he can do no harm if he takes no part, and forms no opinion. Bad men need nothing more to compass their ends, than that good men should look on and do nothing. He is not a good man who, without a protest, allows wrong to be committed in his name, and with the means which he helps to supply, because he will not trouble himself to use his mind on the subject.”
So, I say to all, do not become complacent with your Tricare and Tricare for Life benefits.
Under current law, TRICARE dependents are only permitted to stay on their parents’ policies until they are 21 years old; unless they are enrolled in a full-time in an approved institution of higher learning and the parent provides more than half of the dependent’s financial support, then they can remain on the TRICARE policy until the age of 23 or until the dependent is out of school, whichever comes first.
Congress is pushing a new House Bill, HR 475, that will allow those “children” will remain on their parents’ policies until age 26 without premium increases, whether they are eligible to enroll in an employer sponsored plan or not.
That means, even if they are college graduates, age 25, working in big business, earning a possible 6-figure salary, they will have all their medical care paid for by TRICARE.
That also means they would still have ID cards enabling them to shop in the Commissaries, the Exchanges, and take full advantage of all Morale, Welfare, and Recreation (MWR) privileges.
It was only a year or so ago when the Congressional Budget Office (CBO) again recommended raising TRICARE Fees by raising TRICARE enrollment fees for military retirees and instituting enrollment fees for TRICARE for Life (TFL). That would have meant retirees would have had an annual enrollment fees of $485 for an individual or $970 for a family for TRICARE for Life, in addition to the Medicare premiums military retirees 65 and older pay already pay.
Additionally, the CBO wanted to introduce minimum out-of-pocket requirements for those using TRICARE for Life. They proposed that TFL would not cover any of the $750 of cost-sharing payments under Medicare and would cover just 50 percent of the next nearly $7,000.
Moreover, they were not done there, the CBO also wanted to reduce or eliminate the eligibility for disability compensation for various diseases the Government Accountability Office has said are not caused or aggravated by military service. They also wanted to end the VA’s individual unemployability payments to disabled veterans when they turn 67. Then they wanted to reduce the disability benefits to veterans older than 67 who are receiving Social Security payments. Then they wanted to eliminate disability compensation for veterans with a disability rating below 30 percent. In addition, they were not sated with those suggestions, they wanted to make VA disability payments taxable income.
I know many, many people feel that the military, like the police, needs defunding. Many more feel that retired and disabled military veterans are a drain on the economy especially now that we are no longer at war, but the world is not the “feel good” place they seem to think they live in.
We are not “low hanging fruit” to be used as pawns in the budget balancing process. We are the people who gave so much to this country to make it what it is and some gave it all, and their families need to be protected.
Please do not sit idly by while Congress wastes our precious allotted military healthcare dollars when the Affordable Care Act or their employers’ health plans can already fill any need these “children” up to age 26 may have.
I wrote my Senators and Congressional Representative to express my feeling concerning this; let the “grass roots” writing campaign begin here. Protect your rights, you served your country, you pay your taxes, and you have every reason to expect your benefits to continue without higher costs or reduced benefits!
Just saying…