The Extended Care Health Option program is an auxiliary program through TRICARE that caters towards the financial needs of eligible active duty military and family members who have been assessed and confirmed to have a physical or mental disability. The services and supplies offered under this program cover a wider range than those offered through TRICARE Extra, Standard and Prime.
The benefits provided in this program include a $2,500 cost–share which is paid monthly by the government for every qualified family member. Beneficiaries with conditions that subject them to homecare are eligible for the ECHO Home Health Care (EHCC) program. This program provides crucial medical services given by skilled medical professionals at the beneficiary’s home. (See more information on the cost-share program at the end of this article).
Who Qualifies for the ECHO Program
The eligibility criteria for joining this program is detailed below for TRICARE-qualified spouses or children of the individuals who meet the following:
- Must be a Uniformed Services member of the United States military. This includes Reserve members whose activation period is more than 30 days.
- Is an ex-Uniformed Services member of the United States military whose spouse or child has suffered physical or emotional abuse.
The following conditions must also be met by the active duty family members for consideration for the program:
- Individuals are qualified for the TRICARE continued medical benefits through the Transitional Assistance Management Program (TAMP).
- The individual is suffering from a moderate to severe intellectual disability.
- The individual is suffering from a serious physical limitation condition.
- The individual has a psychological or physical condition that is serious enough to necessitate home care.
As long as the principle member or sponsor remains in the military, beneficiaries can retain their ECHO services eligibility. This also applies to the sponsor’s children who have reached the eligible age limit of either 21 or 23 (23 for full-time college students) under the basic TRICARE coverage program. In addition, the child must have been suffering from a physical or mental disability that prevents them from being able to be self-supportive before their eligibility age expires and are receiving more than half of their basic needs from their sponsor.
Benefits Offered through the ECHO Program
- Rehabilitation and medical services
- Training on how to use assistive technology devices
- Exclusive education
- In the case where a residential environment is required, institutional care will be provided
- Transportation will be provided under specific circumstances
- Assistance from qualified translators or interpreters and other assistive services
- Supply of long lasting equipment which is inclusive of maintenance and adaptation
- Provision of TRICARE EHCO expanded home care medical services
- Temporary care services provided in-home
- TRICARE ECHO Respite Care provided 16 hours every month for those receiving other approved ECHO benefits
- TRICARE ECHO Home Health Respite Care provided for a maximum of 40 hours per week for eligible members (8 hours a day/5 days a week)
Coverage Cost Limits and Government/Sponsor Liability
A maximum of $30,000 for every beneficiary is provided by the government per fiscal year (October 1-September 30) to meet the expenses of all combined ECHO benefits, with the exclusion of ECHO Home Health Care (EHHC).
In the case where a sponsor has two people receiving ECHO benefits, he or she will pay a one month cost-share while TRICARE will pay a maximum of $2,500 for each beneficiary, with the exception of ECHO Home Health Care benefits. The sponsor will pay any additional costs if TRICARE’s provision does not cover the entire cost.
Exceptional Family Member Program (EFMP)
The EFMP is a program offered by the Department of Defense to provide support to service members whose family members have special needs. Visit, Military Home Front for additional information about the Exceptional Family Member Program.