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 enlistment or appointment date is before Jan. 1, 2018.
- Group B: Sponsor's enlistment 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
- enrollment fees under TRICARE Prime and TRICARE Select plans
|
- TRICARE Prime point-of-service deductible and cost-share amounts
- payments for non-covered services
- premiums paid under TRICARE Reserve Select, TRICARE Retired Reserve and TRICARE Young Adult
|
2023 Catastrophic Cap Amounts
| 2023 |
Group A |
Group B |
|---|
Active Duty Family Members
|
Prime and Select: $1,000 per family, per calendar year |
Prime and Select: $1,217 per family, per calendar year |
Retirees and Their Family Members
|
Prime: $3,000 per family, per calendar year
Select: $4,028 per family, per calendar year |
Prime and Select: $4,262 per family, per calendar year |
| Medically Retired and Their Family Members or Survivors |
Prime and Select: $3,000 per family, per calendar year
|
Prime and Select: $4,262 per family, per calendar year |
| TRICARE Reserve Select (TRS) |
$1,217 per family, per calendar year |
| TRICARE Retired Reserve (TRR) |
$4,262 per family, per calendar year |
| TRICARE Young Adult (TYA) |
Active Duty Family Members: $1,217 per individual, per calendar year
Retiree Family Members: $4,262 per individual, per calendar year |
