TRICARE Catastrophic Cap: 2026 Guide to Out-of-Pocket Limits
*TRICARE.Com is an independent reference site and is not part of the official TRICARE program or the Department of Defense. For official policy and the most current data, visit TRICARE.mil.*
## Quick answer The TRICARE Catastrophic Cap is the maximum amount you will pay out-of-pocket for covered medical services each calendar year. Once your family’s combined spending on deductibles and copays reaches this limit, TRICARE pays 100% of the cost for all covered services for the remainder of the year.
## In detail The catastrophic cap is your financial safety net. It ensures that a major illness or injury doesn't lead to unlimited medical debt. It resets every year on January 1.
### What counts toward the cap? Most standard healthcare costs apply to your catastrophic cap, including: * Annual deductibles. * Copayments (flat fees for visits). * Cost-shares (percentage-based sharing of costs). * Pharmacy copayments for prescriptions filled via Express Scripts. * Point-of-Service (POS) charges for TRICARE Prime (if you are a retiree—see note below).
### What does NOT count? * **Monthly premiums** (for TRICARE Reserve Select, Retired Reserve, Young Adult, or Prime Enrollment fees). * **Non-covered services** (e.g., cosmetic surgery, experimental treatments). * **Balance billing** charges from non-participating providers (amounts exceeding the TRICARE-allowable charge). * **Point-of-Service (POS) fees** for Active Duty Family Members.
### 2026 Catastrophic Cap Rates Cap amounts are determined by the sponsor's status and their "Group" (Group A joined before Jan 1, 2018; Group B joined on or after that date).
| Beneficiary Type | Group A | Group B | | :--- | :--- | :--- | | **Active Duty Family Members** | $1,000 | $1,288 | | **Retirees / Others (TRICARE Prime)** | $3,000 | $4,383 | | **Retirees / Others (TRICARE Select)** | $4,171 | $4,383 |
*Note: These are 2026 rates. Rates typically adjust annually based on the retiree cost-of-living adjustment (COLA). For the most current figures, consult the TRICARE.mil/costs page.*
## Who this applies to * **Active Duty Families:** Enjoy the lowest caps ($1,000–$1,288 in 2026) to ensure military readiness and family stability. * **Retirees and their Families:** Have higher caps that vary significantly between Group A (older legacy members) and Group B (newer members). * **TRICARE Reserve Select (TRS) / TRICARE Retired Reserve (TRR):** These members follow the Group B cap rates regardless of when they joined. * **TRICARE For Life (TFL):** TFL beneficiaries also have a catastrophic cap ($3,000 for Group A in 2026) which applies to costs not covered by Medicare but covered by TRICARE.
Common scenarios
### Scenario 1: The Active Duty Surgery (Group A) Technical Sergeant Smith’s daughter requires a series of surgeries. Between pharmacy copays and specialty care cost-shares, the family reaches $1,000 in out-of-pocket costs by May. For the rest of 2026, the family pays $0 for all TRICARE-covered medical visits and prescriptions.
### Scenario 2: The Retired Family on Select (Group B) A retired officer in Group B uses TRICARE Select. Their annual cap is $4,383 (2026 rate). After a major car accident, their hospital cost-shares and outpatient physical therapy fees hit the $4,383 limit by September. From October through December, TRICARE pays the full allowable amount for all covered services.
### Scenario 3: Crossing the Limit with Pharmacy A retiree manages a chronic condition with expensive maintenance drugs. Over the course of the year, their $68 Tier 3 (non-formulary) mail-order copayments add up. Once these pharmacy costs—combined with their doctor visit copays—hit their specific catastrophic cap, their prescriptions become $0 for the rest of the calendar year.
## Related terms * **Deductible:** The fixed amount you pay out-of-pocket each year before TRICARE begins to pay for covered services. * **Cost-Share:** The percentage of the total cost of a covered health care service you pay (common in TRICARE Select). * **Copayment:** A fixed dollar amount you pay for a covered health care service (common in TRICARE Prime). * **Allowable Charge:** The maximum amount TRICARE will pay for a specific medical service or procedure. * **Enrollment Fee:** The annual amount some retirees and their families must pay to remain enrolled in certain TRICARE plans (does not count toward the cap).
## Sources * TRICARE.mil Costs: [https://www.tricare.mil/costs](https://www.tricare.mil/costs) * Defense Health Agency (DHA): [https://health.mil/](https://health.mil/) * Humana Military (East Region): [https://www.humanamilitary.com/](https://www.humanamilitary.com/) * TriWest Healthcare Alliance (West Region): [https://www.triwest.com/](https://www.triwest.com/)