Category: medicare part d costs

What Are Medicare TrOOP Costs?

Keeping Track of Your Out-of-Pocket Drug Expenses

It’s likely you’ve heard the term “out of pocket,” which refers to the Medicare expenses that aren’t reimbursed by insurance. A less familiar term, but one that is extremely important to Medicare Part D prescription drug plan members who enter the Coverage Gap, is “true out-of-pocket” or “TrOOP” costs. Your Medicare TrOOP expenses determine when you’ll leave the Coverage Gap, which is the third stage of the standard Medicare Part D benefit, and when you’ll enter Catastrophic Coverage, the fourth and final stage of the benefit. To better understand these coverage stages, please watch this video.

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Getting to Know Your Part D Plan’s Drug List

What Medications Are Not Covered by Medicare Part D

A plan’s drug list or “formulary” is an important consideration when choosing your Part D coverage. The drug list changes each year depending on the rules and guidelines released by the Centers for Medicare & Medicaid Services (CMS) which prescription drug plans (Part D) and Medicare Advantage Plans must follow. These formulary guidelines state that plans must base their decisions on scientific evidence and well-established guidelines to cover today’s most widely used medications. This ensures that beneficiaries like you will be covered by the most commonly used and effective medications available to protect your health. (more…)

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