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Catastrophic Cap

The catastrophic cap is the maximum out-of-pocket amount the beneficiary will pay each calendar year for TRICARE-covered services. The beneficiary is not responsible for any amounts over the catastrophic cap in a given year, except for:

  • Services that are not covered.
  • Point of Service charges.
  • The additional 15 percent non-participating providers may charge above the TRICARE allowable charge.

If the beneficiary changes programs during the calendar year under the same sponsor, any amount credited toward the catastrophic cap will roll over to the new program (does not apply to Continued Health Care Benefit Program [CHCBP]).

A beneficiary's catastrophic cap is determined by the sponsor's initial enlistment or appointment date:

  • Group A: Sponsor's enlistement or appointment date is before Jan. 1, 2018.
  • Group B: Sponsor's enlistement or appointment date is on or after Jan. 1, 2018.
Out-of-pocket expenses that apply towards cap Out-of-pocket expenses that do NOT apply towards cap
  • out-of-pocket deductibles
  • inpatient copayments or cost-shares
  • outpatient copayments or cost-shares
  • pharmacy medication costs
  • TRICARE Prime Point of Service deductible and cost-share amounts 
  • payments for non-covered services
  • enrollment fees and premiums

 

2019 Catastrophic Cap Amounts

2019 Group A Group B
Active Duty Family Members 
(TRICARE Prime and Select)
$1,000 per family, per calendar year $1,028 per family, per calendar year
Retirees and Their Family Members 
(TRICARE Prime and Select)
$3,000 per family, per calendar year $3,598 per family, per calendar year
TRICARE Reserve Select (TRS) $1,028 per family, per calendar year
TRICARE Retired Reserve (TRR) $3,500 per family, per calendar year
TRICARE Young Adult (TYA) Active Duty Family Members: $1,028 per individual, per calendar year
Retiree Family Members: $3,598 per individual, per calendar year

2018 Catastrophic Cap Amounts

2018 Group A Group B
Active Duty Family Members
(TRICARE Prime and Select)
$1,000 per family, per calendar year $1,000 per family, per calendar year
Retirees and Their Family Members
(TRICARE Prime and Select)
$3,000 per family, per calendar year $3,500 per family, per calendar year
TRICARE Reserve Select (TRS) $1,000 per family, per calendar year
TRICARE Retired Reserve (TRR) $3,500 per family, per calendar year
TRICARE Young Adult (TYA) Active Duty Family Members: $1,000 per individual, per calendar year
Retiree Family Members: $3,500 per individual, per calendar year