TRICARE Out Of Pocket Maximum: 2026 Catastrophic Cap Guide

The **TRICARE Out-of-Pocket Maximum**, officially called the **Catastrophic Cap**, is the most you or your family will pay for covered medical services in a calendar year. Once you hit this limit through enrollment fees, deductibles, and pharmacy or medical copays, TRICARE pays 100% of the allowable charge for all remaining covered services until the end of the year.

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy, visit TRICARE.mil.*

Details

The catastrophic cap resets every January 1st. It protects families from financial ruin in the event of major illness or injury. However, the specific dollar amount of your cap depends on your sponsor’s initial enlistment date and your specific plan.

### Group A vs. Group B * **Group A:** Sponsors who joined the military before January 1, 2018. * **Group B:** Sponsors who joined the military on or after January 1, 2018.

### 2026 Catastrophic Cap Rates As of the 2026 plan year, these are the standard out-of-pocket maximums for covered services:

* **Active Duty Family Members (All Plans):** * Group A: $1,000 per family. * Group B: $1,313 per family. * **Retirees, Survivors, and Others (TRICARE Prime):** * Group A: $3,000 per family. * Group B: $4,510 per family. * **Retirees, Survivors, and Others (TRICARE Select):** * Group A: $4,371 per family. * Group B: $4,510 per family. * **TRICARE Reserve Select (TRS):** $1,313 per family. * **TRICARE Retired Reserve (TRR):** $4,510 per family.

### What Counts Toward the Cap? Only "allowable" costs count toward your out-of-pocket maximum. These include: * Annual enrollment fees (for TRICARE Prime and TRICARE Select retirees). * Annual deductibles. * Pharmacy copayments (via Express Scripts). * Copayments or cost-shares for doctors, hospitals, and specialty care.

### What Does NOT Count? The following expenses do **not** apply toward your catastrophic cap: * Monthly premiums for TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult. * Point-of-Service (POS) charges for TRICARE Prime (when you see a specialist without a referral). * Amounts charged by non-participating providers that exceed the TRICARE allowable charge. * Services not covered by TRICARE (e.g., cosmetic surgery).

## Who this affects * **Active Duty Families:** Protected by the lowest caps (often $1,000–$1,313). * **Retirees and their Families:** Subject to higher caps based on their group status. * **Guard/Reserve Members:** Those on TRS or TRR (Group B rates apply). * **Survivors:** Retain the cap associated with their sponsor's status.

## Sources * **TRICARE.mil:** [Catastrophic Cap Page](https://www.tricare.mil/Costs/Cap) * **Humana Military (East):** [Cost & Billing Resources](https://www.humanamilitary.com/beneficiary/plans-and-programs/costs) * **TriWest Healthcare Alliance (West):** [Plan Benefits and Costs](https://www.triwest.com/en/beneficiary/tricare-benefits-and-costs/) * **Defense Health Agency (DHA):** [Annual Cost Updates](https://health.mil)