TRICARE Deductibles and Catastrophic Caps Reset Jan. 1
Did you know your TRICARE deductible and catastrophic cap reset every Jan. 1? As always, TRICARE costs depend on who you are as well as your health plan (for example, TRICARE Prime or TRICARE Select). So take a few minutes to re-familiarize yourself with the deductible and catastrophic cap associated with your plan.
A deductible is a fixed amount you pay out of pocket for covered health care services each calendar year before TRICARE pays anything. Enrollment fees aren’t included in your deductible.
Your deductible varies by health plan. If you have TRICARE Select, your deductible depends on your sponsor’s status and rank, and whether they’re in Group A or Group B. There’s no deductible with TRICARE Prime. But you may have to pay a deductible if you see a provider without a referral using the point-of-service option. If you have TRICARE For Life (TFL), you only have to pay an annual deductible for services not covered by both Medicare and TRICARE. Download the TFL Cost Matrix from the TFL page to see what Medicare and TRICARE pay.
Your deductibles reset to $0 every Jan. 1. You can find your deductible on the TRICARE Costs and Fees Sheet.
The catastrophic cap is the most you or your family may pay out of pocket for covered TRICARE health care services each calendar year. This protects you because it sets a limit for the amount you’ll pay annually for TRICARE covered medical services. Each year, your TRICARE Prime or TRICARE Select enrollment fees along with all other out-of-pocket expenses count toward your catastrophic cap. Each Jan. 1, this amount resets to $0.
Once you reach your catastrophic cap, you don’t pay any more of the TRICARE-allowable charge for covered services. This includes enrollment fees for TRICARE Prime and TRICARE Select, costs paid toward annual deductibles, pharmacy copayments, and other cost-shares based on TRICARE-allowable charges. But you’ll have to pay for services that don’t fall under the catastrophic cap protection.
The catastrophic cap doesn’t apply to:
- Services not covered by TRICARE
- Any amount that non-participating providers may charge above the TRICARE-allowable chargeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges. (up to 15% above the allowable charge)
- TRICARE Prime point-of-service charges
- Monthly premiums for TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult
Visit the Cost Terms page to help you better understand your deductible, catastrophic cap, and other TRICARE costs. Then use the TRICARE Compare Cost tool to find your health plan costs, including costs related to TRICARE For Life. For a detailed overview of most costs and fees for TRICARE programs, you can also check out the 2020 TRICARE Costs and Fees Sheet. This is your benefit—take command of your health care by learning about your plan.
Last Updated 6/23/2020