What is the TRICARE out-of-pocket maximum?
Quick Answer
The catastrophic cap limits annual out-of-pocket costs: $1,000 for active duty families, $3,500 for Group A retirees, and $1,000 for Group B retirees.
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Key Takeaways
- Annual limit on your costs
- Varies by beneficiary group
- Most costs count toward cap
- After cap, TRICARE pays 100%
Detailed Answer
The catastrophic cap protects you from excessive healthcare costs.
Catastrophic Cap Amounts (2024)
- Active Duty Family: $1,000
- Group A Retiree: $3,500
- Group B Retiree: $1,000
- Reserve families (TRS): $1,000
What Counts Toward Cap
- Network cost shares
- Non-network cost shares
- Pharmacy copays (most)
- Deductibles
- Inpatient costs
What Doesn't Count
- Prime enrollment fees
- Point-of-service charges
- Non-covered services
- TRICARE Young Adult premiums
When Cap Is Reached
- TRICARE pays 100%
- No more cost shares for year
- Still use authorized providers
- Resets January 1
Tracking Your Cap
- Check EOB statements
- Call regional contractor
- Online beneficiary portal
Related TRICARE Terms
Related Questions
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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