An official website of the United States government
Here's how you know
A .mil website belongs to an official U.S. Department of Defense organization in the United States.
A lock (lock ) or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

News | Jan. 12, 2023

Start 2023 Knowing Your TRICARE Plan’s Catastrophic Cap

By TRICARE Communications

What will happen if doctor visits, medical tests, or even hospital stays start to pile up this year? How will it affect your family’s finances? Fortunately, there’s a set maximum amount you’ll pay out of pocket each year for TRICARE covered services. This amount is known as the catastrophic cap, and it resets every year on Jan. 1.
 
“The TRICARE catastrophic cap is an important part of your health care coverage to understand,” said Debra Fisher, TRICARE Health Plan policy and programs analyst at the Defense Health Agency. “The catastrophic cap helps protect you because it limits your annual out-of-pocket costs for TRICARE covered services.”
 
Every TRICARE plan has a catastrophic cap. Below are some details to help you identify your catastrophic cap and learn how it works.
 
What is your 2023 catastrophic cap amount?
As noted in the TRICARE Costs and Fees Fact Sheet, your catastrophic cap depends on your sponsor’s status and beneficiary group. So, the first thing to understand about your catastrophic cap is what group you’re in:
  • Group A: Sponsor’s initial enlistment or appointment is before Jan. 1, 2018
  • Group B: Sponsor’s initial enlistment or appointment is on or after Jan. 1, 2018
 
For 2023, the catastrophic cap ranges from $1,000 to $4,262. You can find your 2023 catastrophic cap in the table below.
 
Sponsor or Beneficiary Type Group A Group B
Active duty family members $1,000/family $1,217/family
Retirees, family members of retirees, and others $3,000/family (TRICARE Prime)
$4,028/family (TRICARE Select)
$4,262/family
TRICARE Reserve Select Follow Group B $1,217/family
TRICARE Retired Reserve Follow Group B $4,262/family
TRICARE Young Adult Follow Group B $1,217/active duty family members
$4,262/retiree family members
Continued Health Care Benefit Program Follow Group B $4,262/family
TRICARE For Life $1,000/active duty family members
$3,000/all others
 
Which costs apply to your catastrophic cap?
For covered services, out-of-pocket costs that apply toward your catastrophic cap include:
  • Out-of-pocket deductibles
  • Inpatient copayments or cost-shares
  • Outpatient copayments or cost-shares
  • Pharmacy drug costs
  • Enrollment fees under TRICARE Prime and TRICARE Select plans
 
Which costs don’t apply to your catastrophic cap?
Out-of-pocket costs that don’t count toward your catastrophic cap include:  
What happens when you reach your catastrophic cap?
When you or your family reaches your catastrophic cap, TRICARE picks up all remaining covered costs. This means you won’t be responsible for the cost of the TRICARE-allowed portion of any covered service for the rest of the calendar year. However, you’ll still have to pay for services that don’t fall under the catastrophic cap. Your catastrophic cap will reset to $0 on Jan. 1.
 
Does your catastrophic cap reset if you change health plans mid-year?
No. If you change plans during the calendar year under the same sponsor, any amount credited toward the previous catastrophic cap will be credited toward the new catastrophic cap.
 
Understanding your costs is an important step on the way to managing your finances this year. Use the TRICARE Compare Costs Tool and read the TRICARE Costs and Fees Fact Sheet to learn more about your health plan costs. You can also reach out to your TRICARE contractor if you have questions about your out-of-pocket costs.
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
Passengers board an airplane

How to File Your TRICARE Claims Overseas

News
Jan. 30, 2023

Do you need to file a TRICARE Overseas claim for medical care or prescriptions you received overseas? If so,...
Read More
Service member gets flu vaccine

Protect Yourself From Respiratory Illness This W...

News
Jan. 24, 2023

Fevers and sniffles and coughs—oh my! Viruses like COVID-19, flu, and respiratory syncytial virus (RSV) are...
Read More
Woman talking on phone

Update Your Other Health Insurance Info for TRICARE

News
Jan. 17, 2023

The new year is here, so it’s important to take stock of your family’s overall health plan coverage. This is...
Read More
TRICARE January webinar

Learn What’s New in TRICARE Pharmacy Program at ...

News
Jan. 10, 2023

What do recent changes to the TRICARE Pharmacy Program mean for you and your family? Do you need to take any...
Read More
Cigarettes

Resolve To Quit Tobacco With TRICARE’s Help

News
Jan. 04, 2023

Is quitting tobacco your New Year’s resolution? TRICARE and YouCanQuit2 have resources to help you start—and...
Read More
A serviceman is examined at the doctor's office.

Know These TRICARE Basics To Make the Most of Yo...

News
Dec. 28, 2022

Familiarizing yourself with your health plan is key to making the most of your benefits. Here are some TRICARE...
Read More
TRICARE logo

Changes to TRICARE Expected in 2024

News
Dec. 22, 2022

A new TRICARE contract that facilitates beneficiary health care in the civilian sector, known as T-5, is...
Read More
Man looks at phone

4 Changes Coming to TRICARE Pharmacy Program in ...

News
Dec. 21, 2022

As the new year approaches, make sure you’re aware of changes to the TRICARE Pharmacy Program that may affect...
Read More

Jan. 30, 2023

How to File Your TRICARE Claims Overseas

Do you need to file a TRICARE Overseas claim for medical care or prescriptions you received overseas? If so, it’s important to understand the different TRICARE Overseas claim submission methods available to you.

Jan. 24, 2023

Protect Yourself From Respiratory Illness This Winter

Fevers and sniffles and coughs—oh my! Viruses like COVID-19, flu, and respiratory syncytial virus (RSV) are more common during the winter months. These viruses can cause severe illness in some people, so it’s important to know what to do if you feel under the weather.

Jan. 17, 2023

Update Your Other Health Insurance Info for TRICARE

The new year is here, so it’s important to take stock of your family’s overall health plan coverage. This is especially true when it comes to other health insurance (OHI). You may have had OHI last year, but now no longer. Or perhaps you’ve recently gained or changed OHI. In any of these cases, make sure your OHI information with TRICARE is current so your health care claims are processed accurately.

Jan. 12, 2023

Start 2023 Knowing Your TRICARE Plan’s Catastrophic Cap

What will happen if doctor visits, medical tests, or even hospital stays start to pile up this year? How will it affect your family’s finances? Fortunately, there’s a set maximum amount you’ll pay out of pocket each year for TRICARE covered services. This amount is known as the catastrophic cap, and it resets every year on Jan. 1.

Jan. 10, 2023

Learn What’s New in TRICARE Pharmacy Program at January Webinar

What do recent changes to the TRICARE Pharmacy Program mean for you and your family? Do you need to take any action? Learn more during a webinar, “What’s New in the TRICARE Pharmacy Program,” on Thursday, Jan. 26, from 1 to 2 p.m. ET. Sign up now to attend.

Jan. 4, 2023

Resolve To Quit Tobacco With TRICARE’s Help

Is quitting tobacco your New Year’s resolution? TRICARE and YouCanQuit2 have resources to help you start—and finish—your journey to be tobacco-free.

Dec. 28, 2022

Know These TRICARE Basics To Make the Most of Your Plan

Familiarizing yourself with your health plan is key to making the most of your benefits. Here are some TRICARE basics to be familiar with.

Dec. 22, 2022

Changes to TRICARE Expected in 2024

A new TRICARE contract that facilitates beneficiary health care in the civilian sector, known as T-5, is expected to start in 2024. The changes will improve the delivery, quality, and cost of health care services for service members, retirees, and their families.

Dec. 21, 2022

4 Changes Coming to TRICARE Pharmacy Program in 2023

As the new year approaches, make sure you’re aware of changes to the TRICARE Pharmacy Program that may affect you. While these changes offer several enhancements, some of the changes may require action on your part. This will ensure you have access to the prescription drugs you and your family members need.

Dec. 15, 2022

Breast Cancer Reminder: Get Your Annual Screening

Breast health and annual mammogram screenings should be your top priorities to protect against cancers and are easier than ever to schedule wherever you are.

Learn More about COVID-19 and the COVID-19 Vaccine.