Question: Why is the ICL important?
Medicare prescription drug plans use the Initial Coverage Limit (ICL) to define when Medicare
beneficiaries enter the
Donut Hole or Coverage Gap.
If a Medicare Advantage plan (MAPD) follows the defined standard Medicare Part D plan design,
plan members will enter the 2023 Donut Hole when their total negotiated retail prescription drug costs reach
$4,660,
a $230 increase over the 2022 standard of
$4,430.
This means, if your Medicare Part D plan or Medicare Advantage plan follows the
standard defined ICL and you purchase medications with an average retail value of
less than $389 per month,
you will NOT enter the 2023 Donut Hole.
Question: What does it mean when my plan has a higher ICL?
If your Medicare drug plan has an ICL higher than the standard ICL, you will be able to buy
more medications before reaching the 2023 Donut Hole or Coverage Gap.
If your Medicare Advantage plan has an ICL under $4,660, you will be able to buy fewer medications before reaching the 2023 Donut Hole or Coverage Gap.
Remember, in the Initial Coverage phase, when you purchase a drug with a $100 retail cost, the entire $100 retail cost counts toward reaching your ICL. Whereas, only the amount you pay counts toward TrOOP or getting out of the Donut Hole. The portion paid by your Medicare Part D plan does not count toward getting out of the Donut Hole. 2023 Medicare Advantage plan ICL Landscape:
As compared to 2022, five fewer 2023 Medicare Advantage plans will offer an ICL above the standard $4,660 ICL and sixty-nine (69) fewer 2023 Medicare Advantage plans will offer an ICL below the 2023 standard ICL of $4,660 (see the chart below for more details).
In fact, 21 Medicare Advantage plans (MAPDs) will have an ICL above the standard ICL of $4,660 in 2023 (all located in Florida) — with the highest ICL at $11,000 (this means plan members can buy formulary drugs with a retail value up to $11,000 before reaching the Coverage Gap). In 2022, 26 Medicare Advantage plans offered an ICL that was higher than the standard ICL of $4,430.
| 2023 Medicare Advantage Plans Initial Coverage Limits |
|||
| Nbr of 2023 Plans |
ICL | Nbr of 2022 Plans |
Nbr of 2021 Plans |
| ICL | 2023 Plans | 2022 Plans | 2021 Plans |
| n/a | 28 | 42 | 44 |
| $3,885 | 2 | ||
| $3,935 | 1 | ||
| $3,980 | 5 | ||
| $4,080 | 1 | ||
| $4,130 | 4,108* | ||
| $4,150 | 2 | ||
| $4,230 | 64 | ||
| $4,275 | 3 | ||
| $4,300 | 2 | ||
| $4,355 | 2 | ||
| $4,345 | 1 | ||
| $4,430 | 4,460* | ||
| $4,480 | 1 | ||
| $4,500 | 4 | 5 | |
| $4,660 | 4,782* | ||
| $5,000 | 3 | 3 | 4 |
| $6,000 | 3 | 6 | 7 |
| $6,500 | 1 | ||
| $7,000 | 4 | 3 | 3 |
| $7,500 | 1 | 1 | |
| $8,000 | 3 | 4 | 2 |
| $8,500 | 1 | ||
| $9,000 | 1 | ||
| $9,500 | 4 | 3 | 2 |
| $10,000 | 1 | 1 | 1 |
| $11,000 | 1 | ||
Notes: The Medicare Advantage plans with no Initial Coverage Limit are Medicare-Medicaid Plans.
*$4,660 is the 2023 standard Initial Coverage Limit
**$4,430 is the 2022 standard Initial Coverage Limit
***$4,130 is the 2021 standard Initial Coverage Limit
| 2023
Medicare Advantage Plans with Increased Initial Coverage Limit (ICL) |
||
| Location | ICL | Nbr of Plans |
| Miami-Dade | $5,000 | 3 |
| Broward | $5,000 | 1 |
| Miami-Dade | $6,000 | 2 |
| Broward | $6,000 | 1 |
| Miami-Dade | $7,000 | 4 |
| Miami-Dade | $8,000 | 3 |
| Miami-Dade | $8,500 | 1 |
| Miami-Dade | $9,000 | 1 |
| Miami-Dade | $9,500 | 4 |
| Miami-Dade | $10,000 | 1 |
| Miami-Dade | $11,000 | 1 |
The 2023 Medicare Advantage plan information available in our 2023 Medicare Advantage plan finder (or MA-Finder) can also be found directly at: MA-Finder.com/2023.
See how each 2022 Medicare Advantage plan is changing in 2023 using our MA-Compare.com/2023.
For an example, here is a link to Summit County, OH.
Question: Will any 2023 stand-alone Medicare Part D plans have an ICL that is different from the standard?
No. All stand-alone 2023 Medicare Part D prescription drug plans (PDPs) will have an Initial Coverage Limit of $4,660 ICL.
Learn about how Medicare Part D program and plans are changing in 2023 and beyond based on the Inflation Reduction Act of 2022.