TRICARE Catastrophic Cap: 2026 Limits & Rules | TRICARE.com

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## 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 payments for deductibles and copays reach this threshold, TRICARE pays 100% of the cost for all covered services for the remainder of the year.

Details

The catastrophic cap acts as a financial safety net, ensuring that a major illness or injury doesn't lead to financial ruin for military families. It resets every January 1st and is based on a "Calendar Year" cycle.

### What counts toward the cap? The following out-of-pocket costs contribute toward your catastrophic cap: * Annual deductibles. * Copayments (flat fees for visits or prescriptions). * Cost-shares (percentage-based payments). * Pharmacy copays for medications through Express Scripts. * Enrollment fees (for retirees in TRICARE Select or TRICARE Prime).

### What does NOT count? The cap only applies to **covered** services. You are still responsible for: * Monthly premiums (e.g., for TRICARE Reserve Select or TRICARE Young Adult). * Charges for non-covered services (e.g., cosmetic surgery). * Charges from non-participating providers that exceed the TRICARE allowable charge (Balance Billing). * Point-of-Service (POS) charges for TRICARE Prime.

### 2026 Catastrophic Cap Rates The cap amount depends on your sponsor’s status and when they entered the service (Group A vs. Group B).

* **Active Duty Families:** For 2026, the cap is generally **$1,000** per family. * **Retirees and Others (Group A):** For 2026, the cap for TRICARE Prime or Select typically ranges from **$3,000 to $4,000** depending on the specific plan. * **Retirees and Others (Group B - joined after Jan 1, 2018):** These beneficiaries often have a higher cap, approximately **$4,300 to $4,500** for the 2026 plan year.

*Note: Group A includes those whose sponsor joined before January 1, 2018. Group B includes those who joined on or after that date.*

### Tracking your cap You do not need to file a claim to trigger the cap. TRICARE contractors (Humana Military in the East and TriWest in the West) track your expenses automatically. Once the system detects you have reached the limit, your "Explanation of Benefits" (EOB) will show a $0 balance for covered services.

## Who this affects The catastrophic cap applies to all TRICARE beneficiaries, though the dollar amount varies: * **Active Duty Family Members (ADFMs):** Lowest cap to protect serving families. * **Retirees and their families:** Higher caps, tiered by Group A or Group B enrollment. * **National Guard & Reserve:** Applies to those on TRICARE Reserve Select (TRS). * **Survivors and Medal of Honor recipients:** Usually qualify for the lower ADFM or Group A retiree rates.

## Sources * **TRICARE.mil:** [Cost Terms - Catastrophic Cap](https://www.tricare.mil/Costs/Cost-Terms) * **Defense Health Agency (DHA):** [Compare Costs Tool](https://www.tricare.mil/Costs/Compare) * **TriWest Healthcare Alliance:** [West Region Beneficiary Portal](https://www.triwest.com) * **Humana Military:** [East Region Costs](https://www.humanamilitary.com/beneficiary/plans-and-programs/costs)