This stands for the True Out Of Pocket coats of your Medications. It includes your Deductible, copays and the cost share to your Health Insurance Plan. It is used to calculate when you enter into the Coverage Gap A.K.A. the “Doughnut Hole.” In 2022 the gap is reached when the $4430.00 TROOP is reached by you and your carrier. Your cost share will change to Brand Name/Generic Meds- 25% of the cost of the Med. The Gap Phase will continue until the TROOP reaches $7050.00 at which time you will be in the Catastrophic Phase and your cost share will be reduced. Once out of the gap you will pay- Generics- $3.95 or 5% which is ever greater and all other Meds $9.85 or 5% which is ever greater.
The 4 Phases of Medications Coverage–
Deductible
Initial
Gap
Catastrophic
Michael M Insurance Blog