210k views
4 votes
Any money spent during the deductible, initial coverage, and coverage gap stages counts towards the TrOOP costs. What doesn't count toward the TrOOP costs?

User Bitgregor
by
8.2k points

1 Answer

1 vote

Final answer:

Money spent on premiums, pharmacy dispensing fees, and non-covered drugs does not count towards the TrOOP costs in health insurance. Deductibles, copayments, and coinsurance are cost-sharing mechanisms that help in reducing moral hazard by involving the insured party in bearing some of the healthcare costs.

Step-by-step explanation:

Costs that do not count towards the True Out-of-Pocket (TrOOP) costs typically include premiums, pharmacy dispensing fees, and any drugs not covered by the insurance plan. It’s important for policyholders to understand the different cost-sharing mechanisms employed by health insurance policies, such as deductibles, copayments, and coinsurance.

Money spent during the deductible period, initial coverage, and coverage gap stages helps to reduce the insured party's moral hazard by sharing some costs before benefits are collected. However, premiums and other non-covered items do not contribute to the accumulation of TrOOP costs and therefore do not help in reducing moral hazard in the same way. Understanding the expenses that do not count toward TrOOP is crucial for managing out-of-pocket healthcare costs effectively.

User Cagatay Barin
by
8.2k points