Catastrophic Cap
Quick Definition
Maximum out-of-pocket expenses for covered services each fiscal year.
Video Explanation
Full Definition
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.
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.
How does TRICARE cover autism spectrum disorder?
TRICARE covers autism diagnosis, ABA therapy, speech therapy, occupational therapy, and medication through the Comprehensive Autism Care Demonstration.
How much do prescriptions cost with TRICARE?
Prescription costs vary by location: military pharmacies are free, network pharmacies charge $13-$60 copays, and home delivery offers lower costs for 90-day supplies.
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 is the TRICARE out-of-pocket maximum?
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.
Are there financial assistance programs for TRICARE costs?
Some pharmaceutical manufacturers offer copay assistance, and the catastrophic cap limits annual costs. Military aid societies may help in emergencies.
What do mental health services cost under TRICARE?
Mental health costs are the same as other healthcare: active duty $0, Prime has low copays, Select has cost shares, and care counts toward the catastrophic cap.
Related Terms
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