TRICARE ECHO helps families with special needs
By Linwood Outlaw III, TRICARE Management Activity
/ Published June 02, 2011
FALLS CHURCH, Va. -- For beneficiaries with specific mental or physical disabilities, TRICARE's Extended Care Health Option provides benefits, including financial assistance that is not available through the basic TRICARE program.
ECHO does not replace benefits from other TRICARE programs; it simply offers supplemental benefits, such as possible coverage for assistive services, durable equipment, transportation, special education, in-home medical services and in-home respite care services.
ECHO is available to active-duty family members, including family members of National Guard and Reserve members activated for more than 30 days; family members eligible for continued TRICARE coverage through the Transitional Assistance Management Program; children or spouses of former service members who were victims of physical or emotional abuse and family members of deceased active-duty sponsors during the period they are in transitional survivor status.
Children may remain eligible for ECHO benefits with no additional premium beyond the usual TRICARE eligibility age limit (21 or 23 if enrolled in college full time) as long as the sponsor remains on active duty, the child is incapable of self-support because of a mental or physical incapacity that occurs before reaching the age limit and the sponsor is responsible for more than one-half the child's support.
Qualifying conditions for ECHO include moderate or severe mental retardation, a serious physical disability and a physical or psychological condition that causes the beneficiary to be homebound.
Under the ECHO plan, active-duty sponsors are responsible for paying a cost share determined by their pay grade and separate from cost shares associated with other TRICARE programs. Regardless of the number of dependents registered in the ECHO, the sponsor pays only one cost share for benefits used in a calendar month. The maximum TRICARE cost share for all ECHO benefits combined, excluding ECHO home health care benefits, is $36,000 per fiscal year. Comprehensive services offered through the ECHO home health care benefit, which provides assistance to beneficiaries who are homebound and generally need more than 28 hours of home-based medical services each week, have their own separate reimbursement rates.
Additional information about ECHO can be found at www.tricare.mil/echo. If beneficiaries believe a qualifying condition exists, they should talk to their regional health care contractor. If stationed overseas, beneficiaries can contact their TRICARE Area Office or military treatment facility. Contact information can be found on TRICARE's website, www.tricare.mil/contactus.