True Out of Pocket, also known as TrOOP, is a Medicare Part D based amount that you pay toward prescription drug costs.
When you enroll in one of our plans, you get credit against your out-of-pocket maximum based on plan contribution. If you choose to enroll in an Enhanced Alternative, or EA, plan, you'll be able to take advantage of a True Out of Pocket credit that gives you credit toward the annual $2,000 out-of-pocket maximum for what both you and your plan spend on Part D drugs. It’s another way that Blue Cross is working to keep your drug costs affordable.
Medicare drug plans, including Prescription Drug Plans and Medicare Advantage Prescription Drug plans, can have different types of drug coverage benefits starting at the base benefit called the Defined Standard, or DS benefit.
In 2025, the annual Medicare Defined Standard, or DS, base drug benefit has a $590 deductible and 25% cost-sharing for all formulary drugs. This means you pay 100% until you meet the deductible; after you meet your deductible, you then pay 25% of the retail drug cost.
Some plans with additional coverage beyond the base DS plan coverage are Enhanced Alternative, or EA, Part D drug plans. They offer supplemental coverage with benefits such as a low or $0 deductible and fixed copays costing you less than you would pay with the Defined Standard benefit.
In 2025, the annual maximum out of pocket prescription drug limit is $2,000.
If you are enrolled in a Medicare drug plan with EA benefits, you will get credit toward your $2,000 spending limit for the greater of your EA plan spending or the spending you would have if you were enrolled in a basic benefit Defined Standard Part D plan.
If you enrolled in an EA Medicare Part D plan, you will get TrOOP credit for what you spend on covered Part D drugs plus what your EA Medicare plan spends toward your Part D drugs – up to the amount you would have spent if you were covered by a base benefit. You will see the TrOOP Credit on your Explanation of Benefits statement.
With this change, you may actually spend far less than $2,000 to meet the $2,000 annual maximum out-of-pocket spending limit depending on the chosen drug plan, retail drug price and the plan's effective drug cost-sharing.