Catastrophic Cap

What is a catastrophic cap?

A catastrophic cap is the most you or your family members pay for covered health care services each calendar year (Jan. 1–Dec. 31).

Once you reach your catastrophic cap, TRICARE pays your portion of the TRICARE-allowable chargeThe maximum amount TRICARE pays for each procedure or service.  This is tied by law to Medicare's allowable charges. for covered services the rest of the calendar year.

What costs count toward my catastrophic cap?

Costs that count toward your catastrophic cap Costs that DON’T count toward your catastrophic cap
  • Costs for TRICARE-covered health care services (inpatient and outpatient)
  • Enrollment fees
  • Deductibles
  • Pharmacy copayments
  • Other cost-shares, based on TRICARE-allowable charges, provider type, and location
  • Costs for non-covered services
  • Extended Care Health Option sponsor or beneficiary liabilities
  • Point-of-service charges
  • Charges from non-participating providers. (You pay the difference between the TRICARE-allowable charge and the balance billing limit, which can be up to 15% above the TRICARE allowable amount.)
  • Monthly or quarterly premiums for TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, or Continued Health Care Benefit Program
  • TRICARE Prime and TRICARE Select enrollees: You no longer pay enrollment fees once you meet your catastrophic cap for the calendar year.
  • TRS, TRR, TYA, and CHCBP enrollees: After you meet your catastrophic cap, you no longer pay for covered services and supplies for the rest of the calendar year. (You have to continue to pay your monthly premium.)

What is my catastrophic cap?

Catastrophic caps may change every year. Below are catastrophic caps for calendar year 2026.

TRICARE Prime and TRICARE Select

My Status Group A Catastrophic Cap Group B Catastrophic Cap
Active duty family member TRICARE Prime or TRICARE Select: $1,000 per family
 TRICARE Prime or TRICARE Select: $1,324 per family
Other than active duty family member TRICARE Prime: $3,000 per family
TRICARE Select: $4,381 per family		 TRICARE Prime or TRICARE Select: $4,635 per family
Survivor of active duty deceased sponsor or medically retired uniformed service member and family members TRICARE Prime or TRICARE Select: $3,000 per family
 TRICARE Prime or TRICARE Select: $4,635 per family

Definitions

  • Group A: Sponsor enlisted or was appointed to the uniformed services before Jan. 1, 2018
  • Group B: Sponsor enlisted or was appointed to the uniformed services on or after Jan. 1, 2018
  • Other than active duty family member: Retirees and their eligible family members or qualified unremarried former spouses

Premium-Based Plans

Premium-based plans are TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the Continued Health Care Benefit Program.

My Status Plan Catastrophic Cap
Member of the Selected Reserve and their family members TRICARE Reserve Select $1,324 per family
Retired member of the Selected Reserve and their family members TRICARE Retired Reserve $4,635 per family
Active duty family member TRICARE Young Adult
 $1,324 per family
Non-active duty family member or family member of deceased active duty sponsor or medically retired sponsor TRICARE Young Adult $4,635 per family
Former active duty sponsor no longer eligible for military health care benefits Continued Health Care Benefit Program $1,324 per family
Retired sponsor no longer eligible for military health care benefits Continued Health Care Benefit Program
 $4,635 per family

TRICARE For Life

The TFL catastrophic cap is $3,000 per family.

Catastrophic Cap Scenarios

There may be times when certain situations affect your family’s catastrophic cap. For example, a family may have some family members enrolled in TRICARE Prime and have a family member enrolled in TYA, a premium-based program.

Below are some scenarios that show what may happen to your catastrophic cap.

Scenario Catastrophic Cap More Information
Active duty family members enrolled in TRICARE Prime, TRICARE Select, or a combination of the two (some TRICARE Prime and some TRICARE Select) Group A: $1,000 per family
Group B: $1,324 per family		 TRICARE Prime and TRICARE Select have the same catastrophic cap in this scenario.
Active duty spouse enrolled in TRICARE Prime; family member enrolled in TYA TRICARE Prime enrollees: $1,000
TYA enrollee: $1,324
Total family catastrophic cap: $1,324 		Once the family catastrophic cap is $1,000, the young adult only continues to pay for health care services until the total catastrophic cap reaches $1,324.
Group A retirees and family members enrolled in TRICARE Prime, TRICARE Select, or a combination of the two TRICARE Prime enrollees: $3,000 per family
TRICARE Select enrollees: $4,381 per family 		Once the TRICARE Prime family catastrophic cap is $3,000, the TRICARE Select enrollee only continues to pay for health care services until the total catastrophic cap reaches $4,381.
Group A retiree spouse and one child enrolled in TRICARE Select, another child enrolled in TRICARE Young Adult TRICARE Select enrollees: $4,381 per family
TYA enrollee: $4,635 		Once the family catastrophic cap is $4,381, the young adult only continues to pay for health care services until the total catastrophic cap reaches $4,635.
Group B retiree spouse and one child in TRICARE Prime; another child enrolled in TRICARE Young Adult $4,635 per family The catastrophic cap is the same for TRICARE Prime and TYA, since the sponsor is in Group B.

If you have questions about your catastrophic cap, you can contact your TRICARE contractor.

Last Updated 1/8/2026