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, enrollment fees, 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 the rest of the year. 

 

These costs don’t count toward your catastrophic cap:

• Point-of-service charges
• Premiums for TRICARE Young Adult, TRICARE Retired Reserve, and TRICARE Reserve Select, and Continued Health Care Benefit Program)
• Costs for non-covered services
• Charges from non-participating providers
• Extended Care Health Option costs

	Calendar Year Catastrophic Cap for TRICARE Plans Stateside and Overseas Your sponsor’s status and beneficiary group determine your catastrophic cap.
	Group A		Group B
	2025	2026	2025	2026
Active Duty Family Members	$1,000/family	$1,000/family	$1,288/family	$1,324/family
Retirees and Family Members of Retirees	$3,000/family (TRICARE Prime) $4,261/family (TRICARE Select)	$3,000/family (TRICARE Prime) $4,381/family (TRICARE Select)	$4,509/family	$4,635/family
TRICARE Reserve Select	Follow Group B	Follow Group B	$1,288/family	$1,324/family
TRICARE Retired Reserved	Follow Group B	Follow Group B	$4,509/family	$4,635/family
TRICARE Young Adult-Prime Option or  TRICARE Young Adult-Select Option	Follow Group B	Follow Group B	$1,288 for an active duty family member $4,509 for a family member of a retiree	$1,324 for an active duty family member $4,635 for a family member of a retiree

 

 

	2025  Calendar Year Catastrophic Cap for TRICARE For Life Stateside and Overseas	2026 Calendar Year Catastrophic Cap for TRICARE For Life Stateside and Overseas
Retirees and Family Members of Retirees	$3,000	$3,000

 

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

West Region Contractor (TriWest Healthcare Alliance)
1-888-TRIWEST (874-9378)
https://tricare.mil/west

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

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