TRICARE Catastrophic Cap: 2026 Limits and Rules | TRICARE.com

The **TRICARE Catastrophic Cap** is the maximum amount you will pay out-of-pocket for covered medical services each calendar year. Once your family’s spending reaches this limit, TRICARE pays 100% of the allowable charge for all remaining covered services for the rest of the year.

*Note: TRICARE.com is an independent reference site and is not the official TRICARE program or a government agency. For official policy, visit TRICARE.mil.*

Details

The catastrophic cap is a financial safety net designed to protect military families from devastating medical debt. It applies to all "allowable charges" for covered services, including annual deductibles, pharmacy co-payments, and enrollment fees (for retirees).

### How the Cap Works As you pay for doctor visits, prescriptions, and hospital stays, those costs accumulate toward your cap. * **Family vs. Individual:** The cap is a family-wide limit. Whether one person has many medical needs or several family members have minor needs, once the total hits the threshold, the cap is met. * **Reset Date:** The cap resets to $0 every year on January 1st.

### 2026 Catastrophic Cap Figures Caps are determined by the sponsor's status and which "Group" they fall into (Group A joined before Jan 1, 2018; Group B joined on or after that date).

* **Active Duty Family Members (ADFMs):** For 2026, the cap is typically **$1,000** for Group A and **$1,288** for Group B. * **Retirees and Others (TRICARE Select/Prime):** The 2026 cap for retirees is approximately **$4,399** (Group A) or **$4,731** (Group B). * **TRICARE Reserve Select (TRS):** The 2026 cap is **$1,311**. * **TRICARE Retired Reserve (TRR):** The 2026 cap is **$4,731**.

*Note: These figures are adjusted annually by the Defense Health Agency (DHA) based on the cost-of-living adjustments.*

### What Does NOT Count Toward the Cap It is critical to understand that the cap only applies to *covered* services. The following do NOT count toward your catastrophic cap and you must continue to pay them even after the cap is met: * Monthly premiums (for TRS, TRR, TYS, or CHCBP). * Point-of-Service (POS) charges for TRICARE Prime (if you see a provider without a referral). * Charges for non-covered services (e.g., cosmetic surgery). * Amounts that exceed the TRICARE "allowable charge" from non-participating providers. * Balances for "balance billing" from non-network providers (up to 15% above the allowable charge).

## Who this affects * **Active Duty Families:** Provides a low-cost ceiling for medical emergencies. * **Retirees and their Families:** Includes enrollment fees in the cap calculation. * **National Guard and Reserve:** Affects those on TRICARE Reserve Select or TRICARE Retired Reserve. * **Survivors and Medically Retired:** Specific protections often keep these groups in the Group A lower-cap category.

## Sources * **TRICARE.mil:** [Catastrophic Cap Overview](https://www.tricare.mil/Costs/Cap) * **Defense Health Agency (DHA):** [Annual Cost Updates](https://health.mil) * **Humana Military (East Region):** [Understanding Costs](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West Region):** [Cost Resources](https://www.triwest.com)