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Tuesday, February 19 2019 @ 03:20 PM UTC

Your TRICARE Benefits in Panama: Catastrophic Cap

Healthcare Mr. Winner, I am a Health Benefits Advisor for TRICARE Latin America and Canada. Last September Colonel Franco, other TRICARE Representatives and myself gave briefings to the TRICARE Retirees in Panama. We have since learned many retirees in Panama are confused about the TRICARE catastrophic cap. Col Colonel Franco asked me to I address this and enlist your help in getting this information out to the Tricare beneficiaries. I am attaching a short article on the subject we would like you to publish. Please let me know if this will be possible and thank you for your assistance. Sincerely, June Walling (Editor's Comment: Here you go. My pleasure, June.)

It has been brought to our attention that there has been some confusion in regards to the catastrophic cap. What does catastrophic cap mean to you? The National Defense Authorization Act for Fiscal Years 1988 and 1989 amended Title 10 of United States Code and placed fiscal year limits known as catastrophic caps on beneficiary liabilities for deductibles and cost-shares under the TRICARE Program. (more)

In 1993 The Defense Authorization Act further amended Title 10 United States Code and reduced the catastrophic cap from $7,500 to $3,000 as the maximum out of pocket expense you incur in a fiscal year. The fiscal year starts on 1 October and ends on 30 September each year. The catastrophic cap is a fixed-level cap per entire family, regardless of how many dependents may be under TRICARE programs.

Whether you are a family of one which may include the sponsor, spouse and a disabled child or your family consists of two or three of those mentioned above, the catastrophic cap will remain at $3,000. For the retiree and/or family the amount is $3,000 per fiscal year. This amount will change only if Congress mandates a change to the TRICARE policy through legislation. All cost shares and deductibles are applied towards this cap. Once this cap has been satisfied you will no longer be required to pay cost shares for the remainder of the fiscal year.

Example: Mrs Jones goes into hospital October 1st with major heart disease requiring open heart surgery. Complications and long hospital stay creates an outstanding claim of $50,000. If TRICARE allows $40,000, your cost share will be 25% of the $40,000. You will owe the facility $10,000. In actuality, you will pay $3,000, which reaches your catastrophic cap, and TRICARE will pay the remaining $7,000 of your share. All other family claims for covered benefits for the remainder of the fiscal year will pay at 100% of allowed charges. You can easily see why a $3,000 cap would be beneficial.


Catastrophic Cap for Family Members of Active Duty is $1,000 per fiscal year. This is the maximum family liability for deductibles and cost shares.

For More Information: Please follow this link if you would like more information about Tricare in Panama.

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