What is the TRICARE catastrophic cap?

The TRICARE catastrophic cap is the annual limit on out-of-pocket healthcare expenses that protects beneficiaries from excessive costs. Once a family reaches the catastrophic cap in a fiscal year (October 1 through September 30), TRICARE pays 100% of all remaining TRICARE-covered services for the rest of that year. For active duty family members, the catastrophic cap is $1,000 per fiscal year. For retirees and their families, the catastrophic cap is $3,500 per fiscal year. Expenses that count toward the catastrophic cap include enrollment fees, deductibles, pharmacy copays, outpatient copays, inpatient cost-shares, and other out-of-pocket costs for TRICARE-covered services. Point-of-service charges (for Prime enrollees who use non-network providers without a referral) and costs for non-covered services do not count toward the cap. Beneficiaries should track their out-of-pocket expenses and can verify their catastrophic cap status through their regional contractor or the Defense Health Agency's claims system.