The most common reason people delay getting help is fear of cost. TRICARE coverage for substance use disorder is genuine and substantial, but the actual amount you pay depends on which plan you have, whether the facility is in-network, and what level of care you need. This page gives you the actual numbers so you can plan before you call.
The figures on this page reflect 2025 TRICARE cost-sharing rates from tricare.mil/Costs. TRICARE updates cost-sharing annually. Always confirm current-year rates with TRICARE or TriWest at 1-888-874-9378 before entering treatment. Active-duty service members always pay $0 for covered care.
Quick reference: costs by plan
| Plan | Annual deductible | In-network inpatient | In-network outpatient | Out-of-pocket max |
|---|---|---|---|---|
| TRICARE Prime (active-duty) | $0 | $0 | $0 | $0 |
| TRICARE Prime (non-active-duty family) | $0 | $0 at MTF. Small co-pay at civilian network.Requires PCM referral | $0 at MTF. Small co-pay at civilian network. | $1,000/year |
| TRICARE Select (under 65) | $150 individual / $300 family | Lesser of $535/day or 25% of allowable chargesAfter deductible, in-network | $25 to $35 co-pay per visit | $3,500/year (retirees in-network) |
| TRICARE for Life | Set by Medicare Part A/B | Typically $0 after Medicare | Typically $0 after Medicare | Set by Medicare |
| Out-of-network (any Prime plan) | N/A | 50% of charges , no cap | 50% of charges , no cap | None |
Plan-by-plan breakdown
TRICARE Prime , active-duty service members
Active-duty service members enrolled in TRICARE Prime pay nothing for covered addiction treatment. There is no deductible, no co-pay, and no annual maximum. This applies to medical detox, residential treatment, PHP, IOP, outpatient therapy, and medication-assisted treatment when using military treatment facilities or TRICARE network civilian providers.
The process for active-duty: start with your PCM at Wilford Hall Ambulatory Surgical Center or your branch’s substance abuse program , Army ASAP at Fort Sam Houston, Air Force ADAPT at Lackland or Randolph, Navy and Marine Corps SARP. They handle the referral and prior authorization for civilian network providers when military treatment facility capacity is limited.
TRICARE Prime , non-active-duty family members
Non-active-duty family members enrolled in TRICARE Prime also pay nothing at military treatment facilities. At civilian network providers with a PCM referral, there is a small co-pay per visit , typically $12 to $30 depending on the provider type. Inpatient care at a civilian network facility requires PCM referral and prior authorization.
The annual out-of-pocket maximum for non-active-duty Prime family members is $1,000 per year. Once you reach that cap, TRICARE covers 100 percent of allowable charges for the remainder of the benefit year.
TRICARE Select
TRICARE Select is the most common plan for military retirees and their dependents in San Antonio. It functions like a PPO , you can see any TRICARE-certified provider without a referral, but prior authorization is still required for inpatient care.
The annual deductible is $150 per individual or $300 per family for active-duty family members, and $150/$300 for retirees and their families (these rates apply to the group E-4 and below or retirees category). Once the deductible is met, you pay cost-sharing of 15 to 25 percent of allowable charges at in-network providers. The annual catastrophic cap for retirees using in-network providers is $3,500, after which TRICARE covers 100 percent for the rest of the year.
TRICARE for Life (TFL)
TRICARE for Life acts as a secondary payer to Medicare. Medicare pays first; TFL covers most or all of what remains. For substance use treatment, Medicare Part A covers inpatient detox and residential treatment; Medicare Part B covers outpatient treatment, PHP, and IOP. TFL then picks up the cost-sharing that would otherwise be the beneficiary’s responsibility.
For most TFL beneficiaries receiving treatment at Medicare-participating providers, out-of-pocket costs are minimal or zero. The Medicare Part A inpatient deductible ($1,676 for 2025) is covered by TFL for the first benefit period. Part B outpatient cost-sharing is also covered by TFL after the Part B deductible ($257 for 2025).
Real-world cost scenarios for TRICARE Select
The following examples are estimates based on 2025 rates for TRICARE Select retiree beneficiaries using in-network providers. Actual costs vary by facility and treatment duration. All scenarios assume the annual deductible has been met.
At the lesser-of formula ($535/day or 25% of allowable charges), a 7-day detox at a facility with a $1,000/day allowable rate would result in $250/day cost-sharing, or roughly $1,750. But the annual out-of-pocket cap limits total year exposure to $3,500.
At 25% of allowable charges, a 28-day stay with a $500/day allowable rate results in $3,500 total cost-sharing , exactly at the annual cap, after which TRICARE covers 100% for the rest of the year.
At roughly $30 per outpatient session, 18 sessions over 6 weeks results in approximately $540 total. IOP is one of the most cost-effective levels of care for TRICARE Select beneficiaries.
PHP cost-sharing runs 20 to 25 percent of allowable charges per day. For a 15-day PHP with a $300/day allowable rate, cost-sharing is approximately $900 , remaining well below the annual cap for most beneficiaries.
Use our free cost estimator to generate a more specific estimate based on your plan type and the level of care you are considering.
The out-of-network cost trap: why it matters
Choosing an out-of-network facility is the single largest driver of unexpected out-of-pocket costs for TRICARE beneficiaries. The cost difference between in-network and out-of-network care is substantial.
For TRICARE Select, out-of-network cost-sharing is 50 percent of TRICARE’s allowable charge , double the in-network rate. But the bigger risk is balance billing. When a facility is out-of-network, TRICARE pays based on its allowable charge, which is typically lower than what the facility actually charges. The facility can then bill you for the difference between TRICARE’s payment and their actual charge. This balance is your responsibility and is not subject to the annual out-of-pocket maximum.
For TRICARE Prime: going out of network without authorization is even more expensive. The point-of-service option charges 50 percent of the billed amount with a separate $300 individual deductible and no annual maximum. This is rarely a good option.
The practical rule: always verify that a facility is in-network with TriWest before admission. Call TriWest at 1-888-874-9378 and confirm using the facility’s NPI number. Our treatment centers directory lists facilities in San Antonio that accept TRICARE, though network status should always be confirmed directly before admission.
How the annual out-of-pocket cap protects you
TRICARE has an annual catastrophic cap that limits total cost-sharing in a benefit year. Once you reach the cap, TRICARE covers 100 percent of allowable charges for the rest of that year. This is particularly relevant for higher levels of care like residential treatment.
For 2025, the relevant caps are: $1,000 per year for active-duty family members enrolled in TRICARE Prime; $3,500 per year for retirees and their families using in-network providers under TRICARE Select; $7,500 per year for retirees and their families using out-of-network providers (this cap does not include balance billing amounts, only TRICARE’s cost-sharing). The cap resets each January 1.
If you are beginning treatment in the second half of the year and the level of care needed would exceed the annual cap, consider the timing. A 28-day residential stay that begins in November might use up the cap for the current year, leaving the remaining treatment in the new year with a fresh deductible. A case manager or TRICARE benefits advisor can help you plan around this.
What does not count toward the deductible or cap
Not every treatment-related cost applies to the TRICARE deductible or out-of-pocket maximum. Understanding these exclusions prevents surprises.
Costs that do not count: balance billed amounts from out-of-network providers, facility charges above TRICARE’s allowable rate, non-covered services and amenities, and charges from providers who do not participate in TRICARE. These amounts are your full responsibility and can be significant at facilities that are out of network or that charge luxury rates above the TRICARE allowable.
Costs that do count toward the annual cap: your TRICARE cost-sharing portion at in-network providers, deductible payments, and co-pays at network providers all count toward the catastrophic cap. Keep records of all payments so you can track your progress toward the cap and request an adjustment if you believe you have overpaid.
If cost is still a barrier
For veterans and service members for whom even TRICARE cost-sharing is difficult, additional options exist.
VA benefits: if you are a veteran with VA eligibility, VA substance use disorder treatment is provided at no cost through VA facilities. VA coverage is separate from TRICARE and does not require cost-sharing. See our guide on VA benefits for substance use treatment for details on eligibility and how to access care at the San Antonio VA facility.
TRICARE financial hardship: TRICARE does not have a formal hardship waiver for cost-sharing, but active-duty sponsors can contact their installation’s financial counseling program for assistance with medical costs. Military OneSource also provides free financial counseling for service members and families.
Payment plans: most in-network facilities will work with TRICARE beneficiaries to structure payment plans for the cost-sharing portion. Ask the facility’s financial counselor before admission rather than after discharge.
Common questions
Ready to understand your specific costs?
Use our free cost estimator, or call TriWest at 1-888-874-9378 to get an estimate for the specific level of care and facility you are considering. If you are in crisis, the Veterans Crisis Line is available around the clock.
988, press 1 , Veterans Crisis Line