Catastrophic coverage in Part D: when does it begin?

• A. Catastrophic coverage occurs after the beneficiary's total out-of-pocket costs for Part D drugs reach the TrOOP threshold and catastrophic coverage begins.
• B. It begins after a fixed month in the year.
• C. It begins only after the premium is paid.
• D. It begins immediately after plan enrollment.

Answer: (A)

Catastrophic coverage in Part D begins when the beneficiary’s true out-of-pocket costs for covered Part D drugs reach a yearly threshold (TrOOP). Once TrOOP is met, the coverage tier shifts to catastrophic, and the beneficiary pays only a small copay or coinsurance for the rest of the year while the plan covers most of the remaining drug costs. True out-of-pocket costs include deductible payments and the copays/coinsurance you pay for covered Part D drugs, plus amounts paid by both you and the plan that count toward TrOOP. Premiums do not count toward this threshold, and costs for drugs not covered by Part D don’t count toward TrOOP. There isn’t a fixed calendar month or an enrollment-triggered start; it’s the reaching of the TrOOP threshold that ends the coverage gap and triggers catastrophic coverage.