What is TrOOP or True Out-Of-Pocket Costs
TrOOP is the annual "Total out-of-pocket costs" and was also known before as "True out-pf-pocket costs".In general, TrOOP includes all payments for Medications listed on your plan's formulary and purchased at a network or participating Pharmacy. This includes payments that you made and payments that were made by others on your behalf. If you switch Medicare Part D plans during the plan year, your TrOOP will be transferred to your new plan -- it travels with you.
TrOOP is important because after spending $2,100 out-of-pocket in 2026, you move to the Catastrophic Coverage stage of your Medicare Part D coverage. In the Catastrophic Coverage stage, you pay nothing for your formulary drug purchases through the end of the calendar year.
TrOOP includes the amount of your Initial Deductible (if any) and your copayments or coinsurance during the Initial Coverage stage.
TrOOP also includes payments made for your drugs by any of the following programs or organizations: "Extra Help" from Medicare; Indian Health Service; AIDS drug assistance programs; most charities; and most State Pharmaceutical Assistance Programs (SPAPs).
TrOOP costs are those prescription costs that can be used to calculate when you exit the Initial Coverage phase and enter the Catastrophic Coverage phase of your Medicare Part D Coverage. The 2026 plan year out-of-pocket threshold or maximum TrOOP before exiting the Initial Coverage phase is $2,100. This threshold is also know as the RxMOOP.
What is excluded from TrOOP?
- Plan premium payments.
- Non-Formulary medications - prescription drugs not included on your plan’s drug list. See: How to Request a formulary exception to get a medication added to your drug list.
- "Bonus Drugs" - drugs covered by your plan’s supplemental coverage.
- Medication not covered by all Medicare Part D plans - for instance, over-the-counter drugs, drugs you receive during a hospital stay, or drugs prohibited from Part D coverage by law.
- Drugs purchased outside of the United States.
- Payments made for your drugs by any of the following programs: employer or union health plans; TRICARE; VA; Worker’s Compensation; and some other programs.