"[t]rue out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan out-of-pocket threshold of [($8,000 in 2024 and $2,000 in 2025). Read more about changes coming in 2025]. TrOOP costs determine when a person’s catastrophic coverage will begin." [links and annual values added]
"Part D rules [42 CFR §423.104(d)] require sponsors to track the beneficiary’s TrOOP and correctly apply these costs to the TrOOP limit in order to provide enrollees the catastrophic level of coverage at the appropriate time. The TrOOP threshold is calculated on an annual basis and must be transferred between Part D sponsors if a beneficiary disenrolls and re-enrolls at any time before the end of a coverage year or whenever a Part D plan other than the plan of record has paid. Sponsor collection, and transfer if appropriate, of the TrOOP and gross covered drug spending balances are essential for sponsors to correctly manage the Part D benefit.". (page 36) [emphasis added]Medicare Prescription Drug Benefit Manual, Chapter 14 - Coordination of Benefits, (Rev. 18, 09-17-18), Section 50.8 – Transferring TrOOP Balance When a Beneficiary Changes Part D Sponsors (Rev. 17, Issued: 08-23-13, Effective Date: 06-07-10, Implementation Date: 01-01-11), (https://www.cms.gov/ medicare/coverage/ prescription-drug-coverage-contracting/ prescription-drug-benefit-manual)