What is the TRICARE catastrophic cap?

 

 

The catastrophic cap is the most you pay out-of-pocket for covered services each year (January – December). Your deductible, copayments, and cost-shares (including pharmacy) apply to your catastrophic cap. You can check your explanations of benefits (EOB) or call your TRICARE contractor to see if you met your catastrophic cap. Once met, you won’t have any out-of-pocket costs for covered services for the rest of the year. This doesn’t apply to point-of-service charges.

 

	2025  Calendar Year Catastrophic Cap for TRICARE Plans Stateside and Overseas Your sponsor’s status and beneficiary group determine your catastrophic cap for the plans below.
	Group AIf you or your sponsor’s initial enlistment or appointment occurred before January 1, 2018, you are in Group A.	Group BIf you or your sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, are in Group B.
Active Duty Family Members	$1,000/family	$1,288/family
Retirees and Family Members of Retirees	$3,000/family (TRICARE Prime) $4,261/family (TRICARE Select)	$4,509/family
TRICARE Reserve Select	Follow Group B	$1,288/family
TRICARE Retired Reserved	Follow Group B	$4,509/family
TRICARE Young Adult-Prime Option or  TRICARE Young Adult-Select Option	Follow Group B	$1,288 for an active duty family member $4,509 for a family member of a retiree
Continued Health Benefit Program	Follow Group B	$4,509/family

Note: Point-of-service charges and TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult premiums don’t count towards your catastrophic cap.

 

	2025  Calendar Year Catastrophic Cap for TRICARE For Life Stateside and Overseas
Retirees and Family Members of Retirees	$3,000

 

Contact Information
East Region Contractor (Humana Military)
1-800-444-5445
https://www.humanamilitary.com/

West Region Contractor (Health Net Federal Services, LLC) (Through Dec. 31, 2024)
https://www.tricare.mil/About/Changes/TRICARE-West-Region-Transition

TRICARE For Life Overseas Contractor (International SOS)
Country-Specific Toll-Free Numbers
http://www.tricare-overseas.com

TRICARE For Life Contractor (WPS)
1-866-773-0404 / TDD 1-866-773-0405
http://www.tricare4u.com

TRICARE Overseas (including U.S. Territories) International SOS (Overseas Contractor)
Country-Specific Toll-Free Numbers
https://www.tricare-overseas.com/