Qualifying for TRICARE

TRICARE is the Department of Defense’s worldwide healthcare program that provides care to eligible beneficiaries in any of the uniformed services. Active duty service members, National Guard members, Reserve members and their families may qualify for TRICARE.

The uniformed services include:

  • U.S. Army
  • U.S. Navy
  • U.S. Air Force
  • U.S. Marine Corps 
  • U.S. Coast Guard
  • Commissioned Corps of the U.S. Public Health Service
  • Commissioned Corps of the National Oceanic and Atmospheric Administration

Service member programs

Respite care

Respite care is short-term care that provides temporary rest for the primary caregivers of service members. It is available to service members who have a serious injury that has resulted in a physical disability or an extraordinary physical or psychological condition.

Custodial care

Custodial care is non-skilled, personal care for basic day-to-day tasks including help with eating, dressing, moving around and using the bathroom. TRICARE covers custodial care in an institution or at home for seriously-ill or injured service members.

Family member programs

Beneficiaries and family members of active duty service members can benefit from the following programs.

The Extended Care Health Option (ECHO) offers services beyond those offered by TRICARE. It benefits family members who meet certain eligibility criteria and have been diagnosed with: 

  • Moderate or severe intellectual disability
  • Severe physical disability
  • Extraordinary physical or psychological condition

The ECHO Home Healthcare (EHHC) program provided by Maxim provides supplemental services to the family members of active duty service members with mental or physical disabilities including: 

  • Private duty nursing
  • Respite care
  • Part-time and intermittent skilled services
  • Applied behavior analysis care

Home Health Care Benefit provides part-time and intermittent nursing to beneficiaries that do not qualify for skilled care through other TRICARE programs.

The TRICARE Comprehensive Autism Care Demonstration covers ABA services for eligible TRICARE beneficiaries diagnosed with autism spectrum disorder.

ICMP-PEC, also known as the Individual Case Management Program for Persons with Extraordinary Conditions, was a program for TRICARE beneficiaries with extraordinary medical or psychological conditions that lasted from March 1999, to December 2001.

Payment will continue as if the program was still in effect for ICMP-PEC beneficiaries. These payments apply to home health and custodial care services that would otherwise be excluded from coverage under the Home Health Agency Prospective Payment System, the Skilled Nursing Facility Payment System or ECHO until these services are no longer required.

National transfer assistance for military families

Moving to a new duty station? Let Maxim help! We provide assistance for military families in need of private duty nursing under the TRICARE ECHO program.

Contact us for more information:

[email protected]
Phone: 855-444-2916
Fax: 855-444-2917

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