The catastrophic cap is the maximum out-of-pocket amount the beneficiary will pay each calendar year for TRICARE-covered services. The beneficiary is not responsible for any amounts over the catastrophic cap in a given year, except for:

1. Update your TRICARE eligibility status. To update eligibility status for a family member, contact the Defense Enrollment Eligibility Reporting System (DEERS) at (800) 538-9552 and verify what documentation is required for the change. It is the responsibility of the TRICARE beneficiary, parent or legal representative to report a change in status.
2. Note: Visit our Copayment and Cost-Share Information page to view 2020 costs. Ambulatory surgery costs apply to same day surgery in an outpatient hospital setting or ambulatory surgery center. TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.; TRICARE Young Adult costs are based on the sponsor's status.
3. TRICARE is waiving copayments for doctor-ordered, approved COVID-19 testing, including associated office visits furnished on or after March 18, 2020. If you were tested and paid a copayment, you can file a claim for reimbursement.

Note: When enrolled in TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), TRICARE Young Adult (TYA), or the Continued Health Care Benefit Program (CHCBP), Group A beneficiaries follow Group B deductibles and applicable copayments or cost-shares. TRICARE PRIME® (JAN. 31, 2021) Includes TRICARE Prime, TRICARE Prime Remote, the US.

• Services that are not covered.
• Point of Service charges.
• The additional 15 percent non-participating providers may charge above the TRICARE allowable charge.

If the beneficiary changes programs during the calendar year under the same sponsor, any amount credited toward the catastrophic cap will roll over to the new program (does not apply to Continued Health Care Benefit Program [CHCBP]).

A beneficiary's catastrophic cap is determined by the sponsor's initial enlistment or appointment date:

• Group A: Sponsor's enlistement or appointment date is before Jan. 1, 2018.
• Group B: Sponsor's enlistement or appointment date is on or after Jan. 1, 2018.

Out-of-pocket expenses that apply towards cap	Out-of-pocket expenses that do NOT apply towards cap
out-of-pocket deductibles inpatient copayments or cost-shares outpatient copayments or cost-shares pharmacy medication costs enrollment fees under TRICARE Prime and TRICARE Select plans	TRICARE Prime Point of Service deductible and cost-share amounts payments for non-covered services premiums paid under TRICARE Reserve Select, TRICARE Retired Reserve and TRICARE Young Adult

2021 Catastrophic Cap Amounts

2021	Group A	Group B
Active Duty Family Members (TRICARE Prime and Select)	$1,000 per family, per calendar year	$1,058 per family, per calendar year
Retirees and Their Family Members (TRICARE Prime)	$3,000 per family, per calendar year	$3,703 per family, per calendar year
Retirees and Their Family Members (TRICARE Select)	$3,500 per family, per calendar year	$3,703 per family, per calendar year
TRICARE Reserve Select (TRS)	$1,058 per family, per calendar year
TRICARE Retired Reserve (TRR)	$3,703 per family, per calendar year
TRICARE Young Adult (TYA)	Active Duty Family Members:$1,058 per individual, per calendar year Retiree Family Members: $3,703 per individual, per calendar year

2020 Catastrophic Cap Amounts

Tricare Prime East

2020	Group A	Group B
Active Duty Family Members (TRICARE Prime and Select)	$1,000 per family, per calendar year	$1,044 per family, per calendar year
Retirees and Their Family Members (TRICARE Prime and Select)	$3,000 per family, per calendar year	$3,655 per family, per calendar year
TRICARE Reserve Select (TRS)	$1,044 per family, per calendar year
TRICARE Retired Reserve (TRR)	$3,655 per family, per calendar year
TRICARE Young Adult (TYA)	Active Duty Family Members:$1,044 per individual, per calendar year Retiree Family Members: $3,655 per individual, per calendar year

• Copayments and cost-shares are subject to change at the beginning of each calendar year.
  • Copayments are per occurrence or per visit.
  • Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
• Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
• Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries (excluding active duty service members).

Important Note: Active duty service members do not have any out-of-pocket costs for care.

2021 Costs

Active Duty Family Members	Retirees and Their Family Members	TRICARE Reserve Select (TRS)	TRICARE Retired Reserve (TRR)	TRICARE Young Adult (TYA)
Enlisted before 01/01/18	Enlisted before 01/01/18	All	All	All
Enlisted on or after 01/01/18	Enlisted on or after 01/01/18

2021 Cost Information by Benefit

Detailed information on copayments and cost-shares is listed below by benefit. You can also view this information using the cost links in our Benefits A-Z list.

Tricare Humana Copay

Active Duty Family Members	Retirees and Their Family Members	TRICARE Reserve Select (TRS)	TRICARE Retired Reserve (TRR)	TRICARE Young Adult (TYA)
Enlisted before 01/01/18	Enlisted before 01/01/18	All	All	All
Enlisted on or after 01/01/18	Enlisted on or after 01/01/18