Does Tricare Cover Marriage Counseling?

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Yes, Tricare does have provisions for covering marriage counseling, but these are subject to certain conditions.

The policy specifies that coverage for marriage counseling is only granted when it's required for the treatment of a confirmed mental health disorder.

To put it differently, one member of the couple must have symptoms that meet the criteria for a mental health disorder for the counseling to be covered under Tricare.

The responsibility for submitting all claims rests with the certified marriage and family therapists who must sign a participation agreement.

However, there are also instances where Tricare does not cover marriage counseling.

Counseling that is sought for general relationship issues not tied to a diagnosed mental health condition, such as communication problems, disagreements over child-rearing, or financial stress, would not fall under Tricare's coverage.

Furthermore, if the therapy is provided by a professional who does not meet Tricare's certification requirements or has not signed a participation agreement with Tricare, the service will also not be covered. 


Donna Janiec, LPC, NCC

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Limitations and Restrictions of Tricare's Coverage

Tricare's coverage, while comprehensive, does have certain limitations and restrictions that beneficiaries should be aware of.

One significant restriction pertains to marriage counseling. As discussed before, Tricare coverage is only provided for marriage counseling when it's essential for managing a diagnosed mental health issue.

This means that marriage counseling services sought for general relationship issues not tied to a recognized mental health disorder will not be covered.

Moreover, Tricare limits residential treatment to individuals under age 21.

This could potentially affect the accessibility of intensive in-patient therapy for older beneficiaries.

Additionally, while Tricare Select enrollees do not have restrictions on their choice of authorized healthcare providers if they choose a non-network provider, they may face higher out-of-pocket costs.

As for out-of-pocket costs, these can vary depending on the specific Tricare plan.

For instance, Tricare Prime, which is often used by active duty military members and their families, has no enrollment fees for active duty service members, but there are copayments for some services.

On the other hand, the Extended Health Care Option (ECHO) has a coverage limit of $36,000 per year, per beneficiary for all benefits combined, excluding the ECHO Home Health Care (EHHC) benefit.

It's recommended to check your specific plan or contact Tricare directly to understand any potential out-of-pocket costs. 



How to Access Marriage Counseling Through Tricare

Accessing marriage counseling through Tricare involves a few steps. First, it's important to understand that Tricare only covers marriage counseling when necessary for the treatment of a diagnosed mental health condition.

This means that at least one partner in the relationship must have symptoms that meet the criteria for a diagnosable mental health disorder.

To start the process, you can visit the Tricare website and use their "Find a Doctor" tool to locate a certified marriage and family therapist who is covered by Tricare.

It's crucial to confirm that the therapist you choose is a Tricare-authorized provider, as this ensures the services provided will be covered.

Once you've found a suitable therapist, schedule an appointment for an initial evaluation.

During this evaluation, the therapist will evaluate if marriage counseling is essential for the management of a diagnosed mental health disorder.

If the therapist determines that it is, they will submit a request for approval to Tricare.

As for eligibility requirements, any active duty, retired, or eligible family member of a military service member who has Tricare coverage can access marriage counseling if it's deemed necessary for treating a diagnosed mental health condition.

Remember that the coverage is not for general relationship issues but specifically for those tied to a recognized mental health disorder.


Limitations and Restrictions of Tricare's Coverage

Tricare's coverage, while comprehensive, does have certain limitations and restrictions that beneficiaries should be aware of.

One significant restriction pertains to marriage counseling. As discussed before, Tricare coverage is only provided for marriage counseling when it's essential for managing a diagnosed mental health issue.

This means that marriage counseling services sought for general relationship issues not tied to a recognized mental health disorder will not be covered.

Moreover, Tricare limits residential treatment to individuals under age 21.

This could potentially affect the accessibility of intensive in-patient therapy for older beneficiaries.

Additionally, while Tricare Select enrollees do not have restrictions on their choice of authorized healthcare providers if they choose a non-network provider, they may face higher out-of-pocket costs.

As for out-of-pocket costs, these can vary depending on the specific Tricare plan.

For instance, Tricare Prime, which is often used by active duty military members and their families, has no enrollment fees for active duty service members, but there are copayments for some services.

On the other hand, the Extended Health Care Option (ECHO) has a coverage limit of $36,000 per year, per beneficiary for all benefits combined, excluding the ECHO Home Health Care (EHHC) benefit.

It's recommended to check your specific plan or contact Tricare directly to understand any potential out-of-pocket costs.



FAQs about Tricare and Marriage Counseling

Q: What if my spouse is not a military member, can we still get marriage counseling through Tricare

A: Yes, as long as one member of the couple is eligible for Tricare, marriage counseling can be covered.


Q: How can I access marriage counseling through Tricare?

A: To get started, locate a certified marriage and family therapist who is covered by Tricare using their "Find a Doctor" tool.

After you've found a suitable therapist, schedule an initial evaluation. If the therapist determines that marriage counseling is necessary for treating a diagnosed mental health condition, they will submit a request for approval to Tricare.


Q: What are the eligibility requirements for accessing marriage counseling through Tricare?

A: Any active duty, retired, or eligible family member of a military service member who has Tricare coverage can access marriage counseling if it's deemed necessary for treating a diagnosed mental health condition.


Q: Do I need a referral from my primary care manager (PCM) for marriage counseling?

A: For most Tricare plans, you do not need a referral for outpatient mental health services, however, it's always best to check with your specific plan.


Q: Are there any limitations or restrictions on Tricare's coverage for marriage counseling?

A: Yes, Tricare only covers marriage counseling when diagnosed with mental health conditions.

Marriage counseling services sought for general relationship issues not tied to a recognized mental health disorder will not be covered.


Q: Are there any out-of-pocket costs for marriage counseling under Tricare?

Out-of-pocket costs can vary depending on the specific Tricare plan. For instance, Tricare Prime has no enrollment fees for active duty service members, but there are copayments for some services.

It's recommended to check your specific plan or contact Tricare directly to understand any potential out-of-pocket costs.


Q: Does Tricare cover online or telehealth marriage counseling sessions?

A: Yes, Tricare does cover telehealth services, including mental health counseling sessions conducted over a secure video conference.


Q: Where can I find more information about Tricare coverage for marriage counseling?

For more detailed information, you can visit the official Tricare website or contact a Tricare representative. 


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April 20th, 2024

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