How Post Out-of-Pocket (OOP) Threshold Cost-Sharing is Applied in the Part D Plan

SAS Name

This variable Indicates how the Part D plan applies beneficiary cost-sharing once the beneficiary has reached the Medicare-defined Part D annual Out-of-Pocket (OOP) Cost Threshold (i.e., in catastrophic coverage phase).


The CCW constructs the Plan Characteristics File from information submitted by plan sponsors to CMS’s Health Plan Management System (HPMS).

Employer and National Program of All-inclusive Care for the Elderly (PACE) plans are waived from reporting Plan Benefit Package information.

For those plans that did not report, the value of this variable will be blank.

Source: CMS (HPMS Files)

Code Code value
1 Medicare-Defined Post Threshold Cost Sharing
2 Cost Share Tiers