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Tue Jan 17, 2017
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Are there limits on the amount of costs a beneficiary is expected to pay under TRICARE?  
There are annual "caps," or limits, on what you'll have to pay for covered care in any government fiscal year (Oct. 1 through Sept. 30) under all three TRICARE options. Under TRICARE Prime, the cap for active-duty families is $1,000; for all others, it's $3,000 unless you get care on your own, without a referral from your TRICARE Prime PCM, and without an authorization from the health care finder (HCF). This is called using the "point-of-service" (POS) option. If you do this, there's no cap on your expenses in a fiscal year, and you'll be responsible for 50 percent cost-shares on all POS health care charges for the rest of your enrollment period, after you meet the POS deductible amount. The annual fiscal year cap on your expenses under TRICARE Extra and Standard is $1,000 for active-duty families, and $7,500 for all others. Note that the cap applies only to allowable charges for covered services. Charges for services that aren't covered, or the yearly accumulation of what non-participating providers of care may bill you above the allowable charges for the care you received, will not count toward the catastrophic cap.
Keywords: TRICARE, Medical benefits, Insurance, healthcare

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