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This variable is contained in the following files: Plan Characteristics File
SAS Name
POST_OOPT_APPLY

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).

Comments

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)

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