TRICARE Extended Care Health Option (ECHO)

Army Reserve: Retired

Benefit Fact Sheet

Summary

The TRICARE Extended Care Health Option (ECHO) provides supplemental services to active duty Family members (ADFMs) with qualifying mental or physical disabilities. ECHO offers integrated services and supplies beyond those offered by your TRICARE program option (such as TRICARE Prime and TRICARE Select).

Active duty sponsors with Family members seeking ECHO services must sign up for their service’s Exceptional Family Member Program (EFMP) (unless waived in specific situations) and register for ECHO with their regional contractor to be eligible for ECHO benefits.

There is no retroactive registration for ECHO. You must get prior authorization from your regional contractor for all ECHO services.

Eligibility

The following beneficiaries who are diagnosed with moderate or severe intellectual disability, a serious physical disability, or an extraordinary physical or psychological condition may qualify for ECHO:

  • Children or Spouses of former Service members who are victims of abuse and qualify for the Transitional Compensation Programmother hugging her kids

Children may remain eligible for ECHO beyond the usual age limits in some circumstances. If you or your provider believes a qualifying condition exists, talk to a case manager or with your regional contractor to determine eligibility for ECHO benefits.

Benefit Highlights

ECHO provides coverage for the following products and services:*

  • Assistive services (such as those from a qualified interpreter or translator)

  • Durable equipment, including adaptation and maintenance equipment

  • Expanded in-home medical services through TRICARE ECHO Home Health Care (EHHC) (limited to the U.S., the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands)

  • Rehabilitative services

  • Respite care (during any month when at least one other ECHO benefit is received and limited to the U.S., the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands)

    • ECHO respite care: up to 16 hours of care in any calendar month in which any other ECHO-authorized benefit other than the EHHC benefit is also used

    • EHHC respite care: up to eight hours per day, five days per week (for those who qualify)

  • Training in use of special education and assistive technology devices

  • Institutional care when a residential environment is required

  • Transportation to and from institutions or facilities in certain circumstances

Note : Applied behavior analysis (ABA) services are covered under the Comprehensive Autism Care Demonstration. There are no yearly or lifetime caps on the amount of ABA TRICARE covers. EFMP enrollment and ECHO registration are required for ADFMs to qualify for ABA services under the Autism Care Demonstration. For more information, go to www.tricare.mil/autism.

TRICARE does not pay for services provided by Family members, trainers, or other individuals who are not TRICARE-authorized providers. For more information, go to www.tricare.mil/echo.

* You must get prior authorization from your regional contractor for all ECHO services.

Conditions to qualify for ECHO coverage may include, but are not limited to:

  • Autism spectrum disorder

  • Moderate or severe intellectual disability

  • Serious physical disability

  • Extraordinary physical or psychological condition of such complexity that the beneficiary is homebound

  • Diagnosis of a neuromuscular developmental condition or other condition in an infant or toddler (under age 3) that is expected to precede a diagnosis of moderate or severe intellectual disability or a serious physical disability

  • Multiple disabilities, which may qualify if there are two or more disabilities affecting separate body systems

Children may remain eligible for ECHO benefits beyond the usual TRICARE eligibility age limit (age 21, or age 23 if enrolled in a full-time course of study at an approved institution of higher learning) provided all of the following are true:

  • The sponsor remains on active duty

  • The Child is incapable of self-support because of a mental or physical incapacity that occurs prior to the loss of eligibility

  • The sponsor is responsible for over 50 percent of the Child’s financial support

Cost and Coverage Limits

The coverage limit for all ECHO benefits combined, excluding ECHO Home Health Care (EHHC), is $36,000 per beneficiary, per calendar year. The ECHO benefit cap is applied based on a calendar year (January 1 – December 31).

ECHO-allowable amounts are not subject to a deductible. The cost-share for every month beneficiaries use ECHO benefits is based on the sponsor’s pay grade, as shown in the following table:

Cost-share

Sponsor Pay Grade

Monthly Cost-Share

E-1 to E-5

$25

E-6

$30

E-7, O-1

$35

E-8, O-2

$40

E-9, W-1, W-2, O-3

$45

W-3, W-4, O-4

$50

W-5, O-5

$65

O-6

$75

O-7

$100

O-8

$150

O-9

$200

O-10

$250

Costs can’t be shared between Family members. For example, if an ECHO beneficiary in the household has used only $20,000 toward the $36,000 limit, the $16,000 difference cannot be used or credited to another ECHO beneficiary in the same Family.

Coverage for the EHHC benefit is capped annually. The cap is limited to the maximum fiscal year amount TRICARE would pay if the beneficiary resided in a skilled nursing facility. This amount is based on the beneficiary’s geographic location.

Additional Information
Document Review Date: 10 February 2021