TRICARE Catastrophic Cap: 2026 Rates & Guide
*TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most current data, visit TRICARE.mil.*
## Quick answer The TRICARE Catastrophic Cap (often called the "Catcap") is the maximum amount you will pay out-of-pocket for covered medical services each calendar year. Once your family’s total payments for deductibles, copayments, and enrollment fees reach this limit, TRICARE pays 100% of the allowable charge for all covered services for the remainder of the year.
## In detail The Catastrophic Cap is a critical financial protection for military families, preventing a major illness or injury from causing financial ruin. It resets every year on January 1.
### What counts toward the cap? The following costs apply toward your annual limit: * **Annual deductibles:** The amount you pay before TRICARE begins to share costs. * **Pharmacy copayments:** Costs for prescriptions filled via Express Scripts home delivery or retail pharmacies. * **Enrollment fees:** For plans like TRICARE Prime or TRICARE Select (Retirees only). * **Outpatient/Inpatient cost-shares:** Your percentage of the bill or flat-fee copays for doctor visits and hospital stays.
### What DOES NOT count toward the cap? Certain expenses will not move the needle on your Catcap: * **Monthly premiums:** For premium-based plans (TRICARE Reserve Select, Retired Reserve, Young Adult). * **Point-of-Service (POS) charges:** If you are on Prime and see a specialist without a referral, those extra fees do not count. * **Non-covered services:** Examples include cosmetic surgery or services from non-authorized providers. * **Balance billing:** If you see a non-participating provider who charges more than the TRICARE allowable amount, that "extra" cost is your responsibility and does not apply to the cap.
### 2026 Catastrophic Cap Rates *Note: Rates vary based on the sponsor’s initial enlistment or appointment date (Group A vs. Group B).*
| Beneficiary Type | Group A (Joined before 1/1/2018) | Group B (Joined on/after 1/1/2018) | | :--- | :--- | :--- | | **Active Duty Families** | $1,000 | $1,348 | | **Retirees & Families (Select)** | $4,510 | $4,737 | | **Retirees & Families (Prime)** | $3,000 | $4,737 | | **TRS / TRR / TYA** | N/A | Follows Group B Select rates |
*Source: 2026 TRICARE Desk Reference. Check TRICARE.mil for mid-year adjustments.*
## Who this applies to * **Active Duty Family Members (ADFMs):** Have the lowest caps ($1,000–$1,348) and rarely hit them unless they have high-tier pharmacy needs or use TRICARE Select. * **Retirees and their Families:** Face significantly higher caps. Reaching the cap is common for retirees managing chronic conditions or undergoing major surgeries. * **Guard/Reserve Members:** Those on TRICARE Reserve Select (TRS) follow the Group B Catcap levels. * **TRICARE Young Adult (TYA) Users:** These beneficiaries have an individual cap that follows the sponsor's status and group.
Common scenarios
### Scenario 1: The New Parent (Active Duty) Sgt. Miller is on TRICARE Select (Group A). In March 2026, his spouse has a complicated delivery. Between the deductible and cost-shares for the hospital stay, the family pays $1,000. Because $1,000 is the 2026 Catcap for Group A Active Duty families, every doctor visit or prescription for the rest of the year—even for Sgt. Miller or the new baby—is $0.
### Scenario 2: The Retiree with Surgery Mr. Jones, a retiree in TRICARE Select (Group B), has a knee replacement in February 2026. His deductible is $374, and his cost-share for the surgery is $1,200. He also pays $548 in annual enrollment fees. His total spend is $2,122. He has not hit his $4,737 cap yet, so he continues to pay copays for physical therapy until the total reaches that limit.
## Related terms * **Allowable Charge:** The maximum amount TRICARE will pay for a specific medical service. * **Cost-Share:** The percentage of the allowable charge you pay (typically for TRICARE Select). * **Copayment:** A fixed dollar amount you pay for a service (typically for TRICARE Prime). * **Deductible:** A fixed amount you must pay out-of-pocket before TRICARE cost-sharing begins. * **Group A/B:** Categories based on when the sponsor entered the military (A: before Jan 1, 2018; B: on or after).
## Sources * **TRICARE.mil - Breakdown of Costs:** https://www.tricare.mil/costs * **Defense Health Agency (DHA) - TRICARE Fees:** https://health.mil/Military-Health-Topics/Business-Operations/Pricing-and-Billing/TRICARE-Health-Plan-Costs * **Humana Military (East Contractor):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West Contractor):** https://www.triwest.com/