FALLS CHURCH, Va.   –   Health care costs can feel confusing—but they don’t have to be. TRICARE uses specific terms to describe what you pay and how your benefit works. You may see these terms on your explanation of benefits after getting care. Understanding them helps you plan ahead and avoid unexpected costs.

“Knowing your TRICARE cost terms takes the guesswork out of your health care,” said Ms. Debra Fisher, Health System Specialist, Policy & Programs Branch, TRICARE Health Plan, at the Defense Health Agency. “When you understand what you owe and why, you can make more informed choices and approach your health care with confidence.”

Here’s a guide to the most common TRICARE cost terms.

Deductible

A deductible is the amount you pay before TRICARE begins cost-sharing. Your deductible depends on your plan and whether you have individual or family coverage. Once you meet your deductible, TRICARE starts paying its share of your covered care.

• Applies to: TRICARE Select, TRICARE Select Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult-Select, and TRICARE For Life (for services not covered by Medicare). Beneficiaries with TRICARE Prime only pay a deductible when they use the point-of-service option.
• Real-life example: You have TRICARE Select and your deductible is $150. In January, you have a $150 doctor visit. You pay the full $150 because you haven’t met your deductible yet. After that, TRICARE starts sharing the cost of your covered care for the rest of the year.

Point-of-service fees

The TRICARE Prime point-of-service option allows TRICARE Prime enrollees to receive nonemergency care from any TRICARE-authorized provider without a referral. It offers flexibility but results in higher costs. These are called point-of-service fees, as described in the TRICARE 2026 Costs and Fees Sheet.

• Applies to: TRICARE Prime (doesn’t apply to active duty service members).
• What you’ll pay: You pay an annual deductible of $300 per person or $600 per family first. After that, you pay 50% of the TRICARE-allowable charge. These costs don’t count toward your catastrophic cap.
• Real-life example: You have TRICARE Prime but skip the referral process and go directly to a specialist. You haven’t met your point-of-service deductible yet, so you pay the first $300 yourself. After that, you pay 50% of the allowable charge for each visit. Getting a referral from your primary care manager is usually most cost-effective.

Catastrophic cap

The catastrophic cap is the maximum you pay out of pocket each year for TRICARE-covered services. Once you reach this limit, TRICARE covers 100% of your covered care for the rest of the calendar year.

• Applies to: All TRICARE plans
• What counts toward your cap: Enrollment fees, deductibles, copayments, pharmacy copayments, and other cost-shares based on TRICARE-allowable charges all count. Point-of-service fees for TRICARE Prime don’t count. If you have a premium-based plan, your monthly premiums don’t count.
• Real-life example: You’re a Group A retiree family member with TRICARE Prime. Your catastrophic cap is $3,000. You and your eligible family members have multiple hospitalizations within a calendar year. You keep track of your copayments, deductibles, and cost-shares. Once those add up to $3,000, TRICARE pays the rest of your covered bills for the year at no cost to you.

Know your costs before you get care

Understanding these terms can help you make better choices about your care. Always check whether a provider participates in the TRICARE network before your appointment. Using network providers helps you avoid balance billing and keeps your costs lower.

For more details, visit Cost Terms.

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