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-shareA percentage of the total cost of a covered health care service that you pay. 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-Share|
|E-1 to E-5||$25|
|E-9, W-1, W-2, O-3||$45|
|W-3, W-4, O-4||$50|
The coverage limit for all ECHO benefits combined, excluding the ECHO Home Health Care (EHHC) benefit, is $36,000 per year, per beneficiary. The ECHO benefit cap is applied based on a 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 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 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.
Last Updated 5/29/2019