TRICARE Extended Care Health Option (ECHO)

TRICARE ECHO provides services to Active Duty Family Members (ADFM) who qualify based on specific behavioral or physical disabilities. It offers beneficiaries an integrated set of services and supplies beyond those offered by basic TRICARE health benefit programs (e.g., TRICARE Prime, TRICARE Select). Potential ECHO beneficiaries must be ADFMs, have qualifying conditions and be registered in the Exceptional Family Member Program (EFMP). Each service branch has its own EFMP and enrollment process.

Under certain circumstances, this requirement may be waived. To learn more, contact the beneficiary's service branch's EFMP representative or visit TRICARE.mil. A record of ECHO registration is stored with the beneficiary’s DEERS information. Conditions qualifying an ADFM for ECHO coverage may include, but are not limited to:

  • Moderate or severe intellectual disability
  • Serious physical disability
  • Extraordinary physical or psychological condition of such complexity that the beneficiary is homebound
  • Diagnosis of a neuromuscular developmental condition or other condition in an infant or toddler (under age three) that is expected to precede a diagnosis of moderate or severe intellectual disability or a serious physical
  • Multiple disabilities, which may qualify if there are two or more disabilities affecting separate body systems
  • Participating in the Autism Care Demonstration (ACD) – see TOM Chapter 18 Section 4 for details

Note: Active duty sponsors with family members seeking ECHO registration must enroll in their service branch’s EFMP — unless waived in specific situations — and register to be eligible for ECHO benefits. There is no retroactive registration for the ECHO program. Read more about EFMP

ECHO provider responsibilities

TRICARE providers, especially PCMs, are responsible for managing care for TRICARE beneficiaries. Any TRICARE provider (PCM or specialist) can inform the patient's sponsor about the ECHO benefit.

Refer patients to Humana Military for assistance with eligibility determination and ECHO registration. This ensures both the beneficiary and provider have a complete understanding of the benefit and have taken the necessary steps for efficient claims processing.

Providers must obtain prior authorization for all ECHO services, and they may be requested to provide medical records or assist beneficiaries with completing EFMP documents. Network and participating non-network providers must submit ECHO claims to WPS.

ECHO benefits

ECHO provides coverage for the following products and services:

  • Respite care under the Autism Care Demonstration (ACD) and other services that are not available through schools or other local community resources
  • Assistive services (e.g., those from a qualified interpreter or translator)
  • Durable equipment, including adaptation and maintenance
  • Expanded in-home medical services through TRICARE ECHO Home Health Care (EHHC)
  • Rehabilitative services
  • ECHO respite care (up to 16 hours) during any month when at least one other ECHO benefit is received. (This benefit is limited to the United States, Guam, Puerto Rico and the US Virgin Islands)
  • EHHC respite care: Up to eight hours per day, five days per week
  • Training to use special education and assistive technology devices
  • Institutional care when a residential environment is required
  • Transportation under certain limited circumstances (i.e., to and from institutions or facilities to receive otherwise-allowable ECHO benefits)
Learn more about ECHO and the ACD

Note: All ECHO services require prior authorization from Humana Military. Learn more

ECHO costs

The government’s limit for the cost of ECHO services combined (excluding EHHC) is $36,000 per beneficiary per calendar year. Beneficiaries are responsible for ECHO cost-shares in addition to cost-shares for basic TRICARE benefits (e.g., under TRICARE Prime, TPRADFM, TRICARE Select).

ECHO cost-shares do not count toward the catastrophic cap. EHHC costs do not count toward ECHO yearly maximum cost-shares.

To learn more about ECHO benefits contact a local ECHO case manager at (800) 444-5445.