What is the term used for the maximum out-of-pocket costs a beneficiary pays each calendar year for TRICARE-covered services?

The correct term for the maximum out-of-pocket costs a beneficiary pays each calendar year for TRICARE-covered services is known as the "out-of-pocket maximum." This term specifically refers to the upper limit on the amount individuals must spend on their healthcare before their TRICARE plan begins to cover 100% of the costs for covered services. It helps beneficiaries understand their financial responsibilities in a given year and ensures there is a cap on their healthcare spending, providing essential financial protection.

In contrast, the term "catastrophic cap" generally pertains to limits on out-of-pocket expenses, but it is more commonly associated with specific health plans rather than TRICARE's terminology. "Annual limit" and "benefits limit" are terms that suggest restrictions on the amount of benefits or services provided, rather than the out-of-pocket spending that beneficiaries might incur. Understanding the terminology used in TRICARE is crucial for beneficiaries to navigate their healthcare effectively.