Archive: I received my Part D plan statement and my out of pocket costs are over $700. The total amount of my drug costs are over $2,450 and I will soon reach the $2,830. Do I need to have out of pocket costs or TrOOP reaching $4,550.00 before I'm paid more?

Archive · updated Nov 4, 2018

No. Your out of pocket costs or TrOOP does not determine when you enter the Coverage Gap. Instead, TrOOP determines when you exit the Coverage Gap and enter the Catastrophic Coverage phase of your Medicare Part D plan coverage.

Your Part D prescription drug plan's negotiated retail drug costs determine when you enter the Coverage Gap.

The total negotiated retail drug costs are how much you have spent on your medications to-date plus how much your plan has spent on your medications.

As soon as this combined figure reaches $2,830, your Medicare Part D plan will notify Medicare that you have entered the 2010 Coverage Gap. Then Medicare will send you a check for $250 dollars.You do not need to fill out any paperwork, the rebate happens automatically.