As the new year begins, many government employees and military families take time to review their healthcare costs and plan for the months ahead. If you’re enrolled in a TRICARE health plan (Prime, Select, or other options), you’ve probably encountered terms like deductible, copayment, cost-share, and catastrophic cap. Knowing what these mean and how they work together can help you better anticipate your healthcare spending in 2026.

1. What Is a Deductible?

A deductible is the amount you must pay out-of-pocket for covered services and prescriptions before TRICARE begins sharing costs according to your plan’s rules. Not all TRICARE plans have deductibles:

• TRICARE Prime: Typically has no deductible for most services — unless you use the point-of-service (POS) option for non-referred, non-emergency care.
• TRICARE Select: Generally has an annual deductible that varies by sponsor status, beneficiary group, and whether care is in-network or out-of-network.

You can review official 2026 deductible information and plan cost tables here:
https://www.tricare.mil/Costs/Compare

2. Copayments and Cost-Shares: Your Portion for Care

After meeting your deductible (if your plan has one), most covered services — like doctor visits, procedures, urgent care, and prescriptions — require a copayment (a fixed fee) or cost-share (a percentage of the allowed charge).

These payments count toward your overall out-of-pocket spending for the year. Official definitions for copayments, cost-shares, and deductibles are available on TRICARE’s Cost Terms page:
https://www.tricare.mil/Costs/Cost-Terms

3. The Catastrophic Cap: Your Financial Safety Net

One of TRICARE’s most important protections is the catastrophic cap — the maximum amount you or your family will pay out-of-pocket for covered TRICARE services in a calendar year (January 1 through December 31).

TRICARE’s official explanation of the catastrophic cap can be found here:
https://www.tricare.mil/FAQs/General/GEN_Catastrophic-Cap

What Counts Toward the Catastrophic Cap

Most out-of-pocket costs contribute toward reaching this cap, including:

• Deductibles
• Copayments and cost-shares
• Pharmacy costs
• Enrollment fees for TRICARE Prime and TRICARE Select plans
  (All of these are based on TRICARE-allowable charges.)

What Doesn’t Count

Some items do not count toward your catastrophic cap, such as:

• Premiums for plans like TRICARE Young Adult, TRICARE Retired Reserve, or TRICARE Reserve Select
• Point-of-service (POS) fees under TRICARE Prime
• Costs for non-covered services

Details are outlined directly by TRICARE here:
https://www.tricare.mil/FAQs/General/GEN_Catastrophic-Cap

Why It Matters

Once you and your family reach the catastrophic cap for a calendar year, TRICARE will cover 100% of the TRICARE-allowable cost of covered services for the rest of the year (except for items that don’t count toward the cap). This means no more copays or cost-shares on covered care — a significant protection against unexpected high medical expenses.

4. How Much Is the Cap in 2026?

Your exact catastrophic cap depends on your TRICARE plan and beneficiary group.

According to TRICARE’s official 2026 cost information:

Active Duty Family Members

• Group A: $1,000 per family
• Group B: $1,324 per family

Retirees and Family Members

• TRICARE Prime: $3,000 per family
• TRICARE Select Group A: $4,381 per family
• TRICARE Select Group B: $4,635 per family

You can view TRICARE’s official 2026 cost announcement here:
https://newsroom.tricare.mil/News/TRICARE-News/Article/4328806/learn-your-2026-tricare-health-plan-costs

Tips for the New Year

• Check your plan’s deductible and copay schedule early in January so you know what counts toward the catastrophic cap.
• Review your Explanation of Benefits (EOB) regularly to track your out-of-pocket spending and see how close you are to reaching your catastrophic cap.
• Consider supplement coverage, such as a TRICARE Supplement Insurance Plan, to help cover gaps that TRICARE doesn’t — especially if you expect higher medical expenses during the year.

Understanding deductibles, copayments, and the catastrophic cap — and how they work together in 2026 — can help you approach the year with greater confidence and fewer financial surprises.