Catastrophic cap
The catastrophic cap is the most a family pays out of pocket in a calendar year for covered services — $3,000 per family in both TRICARE for Life and CHAMPVA. Once reached, the program pays your share of covered costs for the rest of the year.
The ceiling, and what counts toward it
Both military wraparounds cap a family's annual exposure at $3,000: TRICARE-covered cost-shares and pharmacy copays accumulate toward TFL's cap, and CHAMPVA's deductible and cost-shares toward its own. In the standard pairing with Original Medicare — where dual-covered services already cost $0 — the cap mostly guards the seams: program-only services, overseas care under TFL, pharmacy copays.
For contrast, Medicare's own architecture: Original Medicare alone has no cap (the gap Medigap and the wraparounds exist to close), Medicare Advantage caps in-network medical costs at $9,250 in 2026, and Part D caps drug costs at $2,100. The VA, a provider rather than an insurer, caps only medications — $700 per year.
You earned these benefits. Make them work together.
Whether you keep exactly what you have or add Medicare coverage alongside it, the right answer depends on your health, budget, and how you like to get care.
No cost, no obligation. You can also get help from Medicare.gov, 1-800-MEDICARE (TTY 1-877-486-2048), or your local SHIP office.