ECHO Benefit Year Changes to Calendar Year
Do you have a family member who gets supplemental services through the TRICARE Extended Care Health Option (ECHO) program? If so, you need to know that beginning on Jan. 1, 2019, the ECHO benefit cap will apply to covered costs during a calendar year and not a fiscal yearClick to closeOctober 1 - September 30. The calendar year runs from Jan. 1 to Dec. 31.
Due to the shift to calendar year, TRICARE adjusted the benefit cap by $9,000 to cover the remaining quarter of this year. This includes the months of October through December. This will allow for a total amount of $45,000, from Oct. 1, 2017 to Dec. 31, 2018. The $36,000 limit for the costs of all ECHO benefits combined will reset on Jan. 1, 2019. This coverage limit doesn’t include ECHO Home Health Care. The benefit cap adjustment this year is for everyone who is in the ECHO program.
ECHO provides services and supplies for active duty family members with special needs. These are services and supplies beyond those offered by your TRICARE program option, such as TRICARE Prime or TRICARE Select. To be eligible for ECHO benefits, you must sign up for your service’s Exceptional Family Member Program (EFMP). Each service branch has its own EFMP and enrollment process. Also, you have to register for ECHO with your regional contractor.
If you need help with ECHO benefits or want to see if you qualify, call your regional contractor. You must get prior authorization from your regional contractor for all ECHO services. Also, a TRICARE authorized provider must provide these services. ECHO benefits include:
- Durable equipment
- Respite care
- Special education
- Transportation in some circumstances
Go to the ECHO page on the TRICARE website to learn more about eligibility, benefits, costs, and coverage limits. You can also download the Extended Care Health Option Fact Sheet for information. If you have questions about ECHO limits and the change to calendar year, contact your case manager.