Fewer Medicare Advantage plans will offer the standard Initial Coverage Limit in 2023
Although, all stand-alone Medicare Part D plans (PDPs) and the vast majority of Medicare Advantage
plans with drug coverage
(
MAPDs)
will use the 2023 standard Medicare Part D
Initial Coverage Limit
(ICL) of $4,660, a few 2023 MAPDs
will have an ICL that is higher or lower than the standard, as detailed in the charts below.
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.
Question: What does it mean when my plan has a lower ICL?
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.
Only three (3) MAPDs will have an ICL below the standard ICL in 2023
as compared to Seventy-two plans with a lower ICL in 2022. The 28 Medicare
Advantage plans with no Initial Coverage Limit are Medicare-Medicaid
Plans.
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
The Medicare Advantage plans with Initial Coverage Limits over the 2023 standard ICL of $4,660
are available in two counties in
Florida.
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.