Costs and Coverage Limits

ECHO has no enrollment fees, but you must pay part of the monthly expenses for authorized ECHO benefits. The monthly copaymentA fixed dollar amount you may pay for a covered health care service or drug. is:

• Based on the sponsor’s pay grade, as shown in the chart below
• Only one fee per sponsor, not per ECHO beneficiary

You only pay the copayment if you use ECHO benefits during that calendar month.

Sponsor Pay Grade	Monthly Copayment
E-1 through 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

ECHO-allowable amounts aren’t subject to a deductible.

Coverage Limits

The coverage limit for all ECHO benefits combined (excluding the ECHO Home Health Care benefit) is $36,000 per beneficiary, per calendar year (Jan. 1–Dec. 31).

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 can’t 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 yearOctober 1 - September 30 amount TRICARE would pay if the beneficiary resided in a skilled nursing facility. This amount is based on the beneficiary’s geographic location.

There are no yearly or lifetime caps on the amount of applied behavior analysis services TRICARE covers through the Autism Care Demonstration.