Tricare Extended Care Health Option

The Extended Care Health Option (ECHO) provides financial assistance to beneficiaries with special needs for an integrated set of services and supplies.

To use ECHO, qualified beneficiaries must:

• Be enrolled in the  Exceptional Family Member Program (EFMP) through the sponsor's branch of service
• Register for ECHO with case managers in each Tricare region

Eligibility

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

• Active duty family members
• Family members of activated National Guard/Reserve members
• Family members who are covered under the  Transitional Assistance Management Program
• Children or spouses of former service members who are  victims of abuse and qualify for the Transitional Compensation Program
• Family members of deceased active duty sponsors while they are considered "transitional survivors."

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 and if the sponsor provides over 50 percent of the financial support) provided all of the following are true:

1. The sponsor remains on active duty
2. The child is incapable of self-support because of a mental or physical incapacity that occurs prior to the loss of eligibility
3. The sponsor is responsible for over 50 percent of the child’s financial support.

ECHO BENEFITS

ECHO provides coverage for the following products and services* :

• Assistive services (e.g., 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 50 United States, 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 50 United States, 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 they also receive any other ECHO authorized benefit other than the EHHC benefit
  • EHHC respite care: up to eight hours per day, five days per week (for those who qualify)
  • Training to use special education and assistive technology devices
• Institutional care when a residential environment is required
• Transportation to and from institutions or facilities in certain circumstances

Tricare does not pay for services provided by family members, trainers, or other individuals who are not authorized.

* All ECHO services require prior authorization from your regional contractor or TAO director overseas.

COVERAGE LIMIT AND GOVERNMENT/ SPONSOR LIABILITY

The government’s limit for the cost of all ECHO benefits combined, excluding the EHHC, is $36,000 per beneficiary, per year. 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:

For More Information

See the Tricare ECHO Website for more details.

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