What is the relationship between premiums and TrOOP in Part D?

• A. Premiums do not count toward TrOOP; only deductibles, copays, and coinsurance for covered drugs count.
• B. Premiums count toward TrOOP.
• C. Premiums are included in the catastrophic threshold.
• D. Premiums are the only cost that counts toward TrOOP.

Answer: (A)

In Medicare Part D, True Out-Of-Pocket costs (TrOOP) determine when you reach catastrophic coverage, and TrOOP is based on the actual amounts you pay for covered drugs. It includes the deductible you pay for drugs, your copays, and your coinsurance for those drugs, as well as any costs you pay while in the coverage gap. Premiums are monthly payments to maintain the plan and are not tied to the amount you spend on medications at the point of sale, so they do not count toward TrOOP. This keeps TrOOP focused on the real drug costs you personally incur, not the overall price of your plan. Therefore, premiums do not count toward TrOOP; only deductibles, copays, and coinsurance for covered drugs do.