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 2022 Donut Hole when their total negotiated retail prescription drug costs reach
$4,430, a $300 increase
over the 2021 standard of $4,130.
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 $369 per month,
you will NOT enter the 2022 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 2022 Donut Hole or Coverage Gap.
If your Medicare Advantage plan has an ICL under $4,430, you will be able to buy fewer medications before reaching the 2022 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. 2022 Medicare Advantage plan ICL Landscape:
As compared to 2021, one more 2022 Medicare Advantage plans will offer an ICL above the standard $4,430 ICL and 63 more 2022 Medicare Advantage plans will offer an ICL below the 2022 standard ICL of $4,430 (see the chart below for more details).
In fact, 26 Medicare Advantage plans (MAPDs) will have an ICL above the standard ICL of $4,430 in 2022 (all located in Florida) — with the highest ICL at $10,000 (this means plan members can buy formulary drugs with a retail value up to $10,000 before reaching the Coverage Gap). In 2021, 25 Medicare Advantage plans offered an ICL that was higher than the standard ICL of $4,130.
| 2022 Medicare Advantage Plans Initial Coverage Limits |
|||
| ICL | Nbr of 2022 Plans |
Nbr of 2021 Plans |
Nbr of 2020 Plans |
| $0 | 42 | 44 | 44 |
| $2,750 | 1 | ||
| $3,570 | 1 | ||
| $3,595 | 1 | ||
| $3,665 | 1 | ||
| $3,750 | 1 | ||
| $3,785 | 2 | ||
| $3,835 | 1 | ||
| $3,880 | 4 | ||
| $3,885 | 2 | ||
| $3,935 | 1 | ||
| $3,980 | 5 | 1 | |
| $4,000 | |||
| $4,020 | 3,656*** | ||
| $4,080 | 1 | ||
| $4,130 | 4,108** | ||
| $4,150 | 2 | ||
| $4,230 | 64 | ||
| $4,275 | 3 | ||
| $4,300 | 2 | ||
| $4,345 | 1 | ||
| $4,430 | 4,460* | ||
| $4,500 | 4 | 5 | 4 |
| $5,000 | 3 | 4 | 4 |
| $6,000 | 6 | 7 | 5 |
| $6,350 | 1 | ||
| $6,500 | 1 | ||
| $7,000 | 3 | 3 | 4 |
| $7,500 | 1 | 1 | |
| $8,000 | 4 | 2 | 3 |
| $9,500 | 3 | 2 | |
| $10,000 | 1 | 1 | 1 |
Notes: The Medicare Advantage plans with a $0 Initial Coverage Limit are Medicare-Medicaid Plans.
*$4,430 is the 2022 standard Initial Coverage Limit
**$4,130 is the 2021 standard Initial Coverage Limit
***$4,020 is the 2020 standard Initial Coverage Limit
The Medicare Advantage plans with Initial Coverage Limits over the 2022 standard ICL of $4,430 are available in three counties in Florida.
| 2022
Medicare Advantage Plans with Increased Initial Coverage Limit (ICL) |
||
| Location | ICL | Nbr of Plans |
| Miami-Dade | $4,500 | 2 |
| Broward | $4,500 | 2 |
| Miami-Dade | $5,000 | 3 |
| Miami-Dade | $6,000 | 5 |
| Broward | $6,000 | 1 |
| Miami-Dade | $6,500 | 1 |
| Miami-Dade | $7,000 | 3 |
| Broward | $7,500 | 1 |
| Miami-Dade | $7,500 | 1 |
| Palm Beach | $7,500 | 1 |
| Miami-Dade | $8,000 | 4 |
| Miami-Dade | $9,500 | 3 |
| Miami-Dade | $10,000 | 1 |
The 2022 Medicare Advantage plan information available in our 2022 Medicare Advantage plan finder (or MA-Finder) can also be found directly at: MA-Finder.com/2022.
See how each 2021 Medicare Advantage plan is changing in 2022 using our MA-Compare.com/2022.
For an example, here is a link to Summit County, OH.
Question: Will any 2022 stand-alone Medicare Part D plans have an ICL that is different from the standard?
No. All stand-alone 2022 Medicare Part D prescription drug plans (PDPs) will have an Initial Coverage Limit of $4,430 ICL.