Does the deductible on a Medicare Part D plan count towards the True Out-of-Pocket Maximum (TrOOP)?

TrOOP is an acronym in Medicare prescription drug insurance standing for True out-of-pocket maximum.  All Medicare Part D plans have the same TrOOP.  TrOOP or true out-of-pocket maximum is the most any beneficiary would pay in any one year for prescriptions out of their own pocket.  The TrOOP number does change each year, and for 2020 the TrOOP amount is $6,350.  With the array of different Part D options on the Medicare market, deductibles on plans vary.  So, one of the most common questions from beneficiaries is:  does the deductible on a Part D plan count towards the plans TrOOP or true out-of-pocket maximum? The answer is yes:  the deductible paid on all Part D plans does count towards the out-of-pocket maximum.  Other than premium payments, all other payments made by the beneficiary such as co-payments or co-insurance counts towards the out-of-pocket cost on medications.  Keep in mind any medications paid for outside of the Medicare prescription drug plan will not count towards the plan’s out-of-pocket maximum. Medications being paid for outside of the plan are usually those that are not on the plan’s formulary.  Another example may be when a member uses a prescription discount card for a medication instead of the Medicare Rx plan.  It is a good idea to follow your payments on medications so that you are aware of where you may be in the Part D stages of the plan.  You should be receiving a statement each month from your Part D plan sponsor that shows this information. Knowing where you are in the Part D drug plan stages, especially as you get close to the out-of-pocket maximum, can help in making strategic choices to optimize reaching that lowest co-payment that occurs after TrOOP has been met.