Understanding ECHO caps important for special needs
Story by: EFMP Staff
Story by: Shari Lopatin, TRIWEST HEALTHCARE ALLIANCE
If a person relies on Tricare to help pay for disabled Family member's special needs, understanding the benefit's financial caps can be helpful.
About a year ago, Tricare stopped its monthly cap of $2,500 for certain services under the Extended Care Health Option. ECHO is Tricare's program for individuals with disabilities, like autism or cerebral palsy. With the ending of ECHO's monthly caps, beneficiaries only have a fiscal year limit of $36,000.
HOW DO THE CAPS WORK?
The yearly ECHO caps are set by Congress and follow the timetable of a fiscal year: Oct. 1 to Sept. 30. During that time span, ECHO won't pay more than $36,000 total. This money can be used all at once or throughout the year. After the new fiscal year begins, that cap is renewed and the Family has another $36,000 available for covered services.
SERVICES ECHO MAY COVER
• Special education and tutoring
• Assistive technology devices
• Care in institutions
• Benefits under the Autism Services Demonstration
• Durable medical equipment
For those who qualify, the ECHO program also may provide an hourly nursing benefit that offers skilled medical help. These hourly nursing benefits are not subject to the $36,000 yearly cap. Instead, they have a different cap based on where the patient lives and the costs of the skilled nursing.
Each calendar month a Family uses ECHO services, they will pay a cost share. The cost share is based on the sponsor's pay grade in the military.
For more information on the ECHO program, visit www.triwest.com/ECHO.