Costs and Coverage Limits
There are no enrollment fees, but you must pay part of the monthly expenses for authorized ECHO benefits. The monthly cost-share is based on the sponsor's pay grade as shown in the chart below. The monthly cost-share is only one fee per sponsor, not per ECHO beneficiary. You only pay the cost-share if you use ECHO benefits during that calendar month.
|Sponsor Pay Grade
||Monthly Cost ShareClick to closeA percentage of the total cost of a covered health care service that you pay.
|E-1 to E-5
|E-9, W-1, W-2, O-3
|W-3, W-4, O-4
The coverage limit for all ECHO benefits combined, excluding the ECHO Home Health Care (EHHC) benefit, is $36,000 per year. This is currently applied per fiscal yearClick to closeOctober 1 - September 30 (Oct. 1–Sept. 30), per beneficiary.
Beginning Jan. 1, 2019, the ECHO benefit cap will be based on a calendar year (Jan. 1–Dec. 31). Because of this shift, the benefit cap will be increased by $9,000 to cover the remaining quarter (Oct. 1–Dec. 31, 2018). This will allow for a total amount of $45,000 from Oct. 1, 2017 to Dec. 31, 2018. The $36,000 total TRICARE coverage limit will reset on Jan. 1, 2019. If you have questions about ECHO limits and the change to calendar year, contact your case manager.
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 cannot 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 year amount TRICARE would pay if the beneficiary resided in a skilled nursing facility. This amount is based on the beneficiary's geographic location.