TRICARE treats substance use disorder as a medical condition and covers treatment across the full range of care levels. Whether the issue involves alcohol, opioids, or another substance, coverage exists for medical detox, residential treatment, partial hospitalization, intensive outpatient, and standard outpatient therapy. The coverage is not automatic at every level , most inpatient care requires prior authorization before admission , but the benefit is real and substantial.
This page explains exactly what TRICARE covers, which plan covers what, what prior authorization means in practice, and what out-of-pocket costs look like. It is written for veterans, active-duty service members, and military families in the San Antonio area covered by TriWest Healthcare Alliance.
All coverage information is drawn from TRICARE.mil and the TRICARE Benefits Handbook. Coverage rules change. Always verify specifics directly with TRICARE or TriWest at 1-888-874-9378 before entering treatment.
What TRICARE covers across the full continuum of care
TRICARE covers substance use disorder treatment at every recognized level of clinical care. The table below shows each level, what it involves, and whether prior authorization is required.
| Level of care | What it is | TRICARE covers? | Prior auth required? |
|---|---|---|---|
| Medical detox | Medically supervised withdrawal, typically inpatient 5 to 10 days. | Yes | Yes , call before admission |
| Residential / inpatient rehab | 24-hour structured treatment in a residential facility. Typically 28 to 90 days depending on clinical need. | Yes | Yes , required before admission |
| Partial hospitalization (PHP) | Day program, typically 5 to 6 hours per day, 5 days per week. No overnight stay. | Yes | Usually yes , confirm with TriWest |
| Intensive outpatient (IOP) | 3 to 4 days per week, approximately 3 hours per session. Compatible with work and family schedules. | Yes | Often required , confirm with TriWest |
| Standard outpatient therapy | Weekly individual or group therapy sessions with a licensed counselor or therapist. | Yes | Usually not required |
| Medication-assisted treatment (MAT) | FDA-approved medications including buprenorphine, naltrexone, or methadone to reduce cravings and prevent relapse. | Yes | Varies by medication and plan |
TRICARE does not set a lifetime cap on substance use disorder treatment days. Coverage continues as long as a licensed clinician certifies that the level of care is medically necessary and the facility submits that documentation through the continued stay review process.
Which TRICARE plan you have and why it matters
Your out-of-pocket cost and how you access covered care both depend on which TRICARE plan covers you. The San Antonio military community is served by four main plans.
Active-duty service members are enrolled in TRICARE Prime and pay nothing for covered treatment. At civilian network providers, there is no cost as long as you have a referral from your Primary Care Manager. Going outside the network without authorization results in significant point-of-service penalties.
At JBSA: start with your PCM at Wilford Hall or your branch’s substance abuse program. They coordinate referrals to civilian network providers when military treatment facility services are at capacity.
TRICARE Select is a PPO-style plan. You can see in-network civilian providers without a referral, though prior authorization is still required for inpatient treatment. In-network cost-sharing is modest , typically 15 to 25 percent of allowable charges after the annual deductible. Out-of-network care is covered but substantially more expensive.
TRICARE for Life works alongside Medicare as a secondary payer. Medicare pays first; TRICARE covers most or all of what remains. Substance use treatment covered by Medicare is also covered by TFL. For most TFL beneficiaries using Medicare-participating providers, out-of-pocket costs for covered treatment are minimal or zero.
National Guard and Reserve members activated for more than 30 consecutive days become eligible for TRICARE Prime. When not activated, TRICARE Reserve Select provides coverage similar to TRICARE Select, with the same prior authorization requirements for inpatient treatment. Premiums apply.
Prior authorization: what it is and the steps to get it
Prior authorization means TRICARE must approve a specific level of care before you enter. For inpatient detox and residential treatment, this step is not optional. Entering without authorization means the claim will be denied and you may be responsible for the full cost of care.
Prior authorization is not the same as a referral. You, your doctor, or the treatment facility can request it directly from TriWest, which manages TRICARE West for San Antonio. Most facilities that regularly treat TRICARE beneficiaries handle the authorization process themselves , but you should always verify this before admission.
Call TriWest before making admission plans
TriWest: 1-888-874-9378. Have your TRICARE member ID, the name of the facility, and the level of care you are considering. They will confirm network status and initiate the authorization process.
A clinical review is conducted
TRICARE or TriWest reviews clinical information , typically a brief intake assessment , to confirm that the requested level of care is medically necessary. For detox and inpatient, this review is usually completed within 24 to 48 hours. Urgent situations can be expedited on the same day.
Get the authorization number in writing
Once approved, you receive an authorization number. Provide it to the facility at admission. The authorization specifies which dates and which level of care are approved. If treatment extends beyond the approved period, the facility must request a continued stay review before the authorization expires.
Know your appeal rights if denied
TRICARE denials can be appealed. If authorization is denied, you have 90 days to file a written appeal. The process has multiple review levels. Our guide on how to appeal a TRICARE denial walks through the exact steps and deadlines.
What you will actually pay out of pocket
Out-of-pocket costs depend on your plan, whether you use in-network providers, and your deductible status. Active-duty service members on TRICARE Prime pay nothing for covered care. The figures below apply to non-active-duty beneficiaries and reflect 2025 TRICARE cost-sharing rates. Verify current-year rates at tricare.mil/Costs.
| Plan | In-network inpatient | In-network outpatient | Out-of-network |
|---|---|---|---|
| TRICARE Prime (non-active-duty) | $0 at military treatment facilities. Small co-pay at civilian network.Requires PCM referral | $0 at MTFs. Small co-pay at civilian network providers. | High point-of-service penalties. Avoid if possible. |
| TRICARE Select | $535 per day or 25% of allowable charges, whichever is less, after deductible.Individual deductible: $150/year. Family: $300/year. | $25 to $35 co-pay per outpatient visit after deductible | 50% of allowable charges after deductible. Annual out-of-pocket maximum applies. |
| TRICARE for Life | Covered after Medicare pays first. Typically $0 at Medicare-participating providers. | Covered after Medicare. Typically $0. | Medicare rules apply first. TFL covers remaining balance. |
Use our out-of-pocket cost estimator to get a realistic cost range based on your TRICARE plan and the level of care you are considering. The estimator is free and does not require you to create an account.
What TRICARE does not cover
TRICARE coverage for substance use disorder is broad, but there are exclusions worth understanding before you plan treatment.
Room and board at a facility that primarily provides housing rather than clinical services is not covered. When a residential facility bills a bundled daily rate that includes both clinical treatment and lodging, TRICARE typically covers the clinical portion. Ask any facility you are considering how they bill TRICARE and whether their daily rate includes items TRICARE will not cover.
Luxury amenities , private rooms beyond medical necessity, spa services, equine therapy marketed as the primary treatment modality , are not covered benefits. The underlying clinical program is covered. The amenities are not.
Court-ordered treatment is not automatically denied, but the legal requirement does not override TRICARE’s medical necessity criteria. If a court orders treatment, TRICARE covers it only if the clinical criteria for that level of care are also met.
Experimental treatments or non-evidence-based modalities may not be covered. If a facility is offering something unusual, verify coverage with TriWest before admission.
Finding a covered facility in San Antonio
San Antonio is covered by TriWest Healthcare Alliance under the TRICARE West region. Before entering any facility, verify that it is both TRICARE-certified and in-network with TriWest.
To verify a facility: search the TRICARE provider directory at tricare.mil/FindDoctor using your zip code and substance use treatment as the specialty. Then call the facility directly to confirm they have an active TRICARE contract and experience billing TriWest. Finally, call TriWest at 1-888-874-9378 to confirm authorization requirements for the specific level of care before admission.
Our treatment centers directory lists facilities in the San Antonio area that work with TRICARE beneficiaries, including network status as reported by each facility. Always verify directly before admission, as network contracts change.
For active-duty service members at JBSA specifically
Active-duty service members have a different access path than retirees and dependents. TRICARE Prime covers care fully, but the process typically starts through your Primary Care Manager or your branch’s substance abuse program, not by calling TriWest directly.
The programs by branch at JBSA: Army ASAP (Alcohol and Substance Abuse Program) at Fort Sam Houston; Air Force ADAPT (Alcohol and Drug Abuse Prevention and Treatment) at Lackland AFB and Randolph AFB; Navy and Marine Corps SARP (Substance Abuse Rehabilitation Program). These programs assess level of care need and coordinate TRICARE-covered civilian treatment when military treatment facility capacity is limited.
If you are active-duty and want to understand what your command will and will not be notified about when you seek treatment, see our guide on self-referral vs command notification at JBSA.
Common questions
Ready to take the next step?
If you or someone in your family needs help finding covered treatment in San Antonio, the Veterans Crisis Line is available around the clock. For non-crisis questions about coverage, call TriWest at 1-888-874-9378.
988, press 1 , Veterans Crisis Line