2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
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2022 OVERVIEW Of MEDICARE PROGRAM BASICS: CHOICE,
2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
MEDICARE PART D: PRESCRIPTION DRUG COVERAGE
PART 3
1.Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for
Medicare and is considering enrollment in Part D prescription drug coverage. On...
and benefits medicare part d prescription drug coverage part 3
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2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
MEDICARE PART D: PRESCRIPTION DRUG COVERAGE
PART 3
1. Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for
Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told
her that she needs to be aware of something called TrOOP. What should you tell her when she asks you
about TrOOP?
a. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into
catastrophic coverage and generally include, in addition to the annual deductible, costs for drugs not on
the Part D plan's formulary and drugs purchased outside the United States. Incorrect
b. TrOOP is calculated on a cumulative basis and consists of the sum of an enrollee's out-of-pocket
deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs.
Incorrect
c. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into
catastrophic coverage and generally include the annual deductible(s) and costs for drugs on the plan's
formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by
the enrollee (like manufacturer discounts) count toward TrOOP. Correct
d. TrOOP is calculated on an annual basis and consists of an enrollee's out-of-pocket deductible plus any
amounts paid on behalf of an enrollee by Medicaid. Incorrect
2. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what they
charge for deductibles, premiums, and cost sharing. How can you explain this to him?
a. The government bases its payments to Part D plans on the standard benefit model. For Part D plans to
receive the full government payment, they must offer the standard model, however, they can take a risk
and revise their benefit structure to attract more beneficiaries. Incorrect
b. The Part D standard model’s importance is that it is the only type of plan into which low-income
beneficiaries can enroll and still receive any extra help for which they may qualify. Incorrect
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