What is the TRICARE catastrophic cap for 2026?
Quick Answer
The TRICARE catastrophic cap limits annual out-of-pocket costs. For 2026, active duty families have a $1,000 cap. Retiree Group A families have approximately a $3,500 cap. Group B retiree families have approximately a $4,500 cap.
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Key Takeaways
- The catastrophic cap limits your annual out-of-pocket medical expenses
- Active duty family cap is $1,000; retiree caps range from $3,500 to $4,500
- Once you hit the cap, TRICARE pays 100% for the rest of the year
- The cap resets every January 1
Detailed Answer
The TRICARE catastrophic cap is the maximum amount you will pay out-of-pocket for covered medical services in a calendar year. Once you reach the cap, TRICARE pays 100% of covered services for the rest of the year.
2026 Catastrophic Cap Amounts (Approximate):
Active Duty Family Members
- Annual cap: $1,000 per family
- Applies to all covered services
- Enrollment fees do not count toward the cap
Group A Retirees and Families (Entered service before Jan 1, 2018)
- Annual cap: Approximately $3,500 per family
- Includes copays, cost-shares, and deductibles
- Enrollment fees do NOT count toward the cap
Group B Retirees and Families (Entered service on/after Jan 1, 2018)
- Annual cap: Approximately $4,500 per family
- Includes copays, cost-shares, and deductibles
- Enrollment fees DO count toward the cap
What Counts Toward the Cap
- Copays for office visits
- Cost-shares for inpatient and outpatient care
- Prescription drug copays
- Emergency room copays
- Deductibles (for Select plans)
- Group B enrollment fees count toward the cap
What Does NOT Count Toward the Cap
- Group A enrollment fees
- Point-of-service (POS) charges
- Costs for non-covered services
- Charges that exceed TRICARE allowable amounts
- Dental and vision premiums
How the Cap Works
- Track your out-of-pocket costs throughout the year
- Your regional contractor tracks claims-based costs automatically
- Once you reach the cap, TRICARE pays 100% for the remainder of the calendar year
- The cap resets on January 1 each year
Tracking Your Costs
- Check your Explanation of Benefits (EOB) statements
- Contact your regional contractor for a summary of year-to-date costs
- Keep receipts for all healthcare expenses
- Prescription costs at military pharmacies ($0) do not count toward the cap
Helpful Tips
- Track your out-of-pocket costs throughout the year using EOB statements
- Contact your regional contractor to check your year-to-date spending toward the cap
- Schedule non-urgent procedures in the same calendar year if you are close to the cap
Related TRICARE Terms
Related Questions
How much does TRICARE cost?
Costs vary by plan and beneficiary status. Active duty members have no costs. Retirees and their families pay enrollment fees and cost-shares.
How does the TRICARE catastrophic cap work?
The catastrophic cap is your maximum annual out-of-pocket cost. Once reached, TRICARE pays 100% of covered services for the rest of the fiscal year.
What are the cost shares for TRICARE Select?
TRICARE Select has annual deductibles, percentage-based cost shares for most services, and a catastrophic cap that limits yearly out-of-pocket costs.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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