Catastrophic Cap

Maximum out-of-pocket expenses for covered services each fiscal year.

The catastrophic cap is the maximum amount you pay out-of-pocket for TRICARE-covered services in a fiscal year (October 1 - September 30). Once you reach this limit, TRICARE pays 100% of the allowable charges for covered services for the rest of the fiscal year.

Catastrophic cap amounts (2024): • Active Duty Family Members: $1,000 • Retirees and their families (Group A): $3,000 • All others: $3,500

What counts toward the cap: • Annual deductibles • Copayments and cost-shares • Pharmacy copays (for TRICARE Select only)

What doesn't count: • Enrollment fees • Premiums • Costs for non-covered services • Amounts over the allowable charge (balance billing)

The catastrophic cap provides important financial protection, ensuring that even families with significant healthcare needs have a maximum annual cost limit. This is especially valuable for families managing chronic conditions or facing major medical events.