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 2021 Donut Hole when their total negotiated retail prescription drug costs reach
$4,130, a $110 increase
over the 2020 standard of $4,020.
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 $344 per month,
you will NOT enter the 2021 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 2021 Donut Hole or Coverage Gap.
If your Medicare Advantage plan has an ICL under $4,130, you will be able to buy fewer medications before reaching the 2021 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. 2021 Medicare Advantage plan ICL Landscape:
As compared to 2020, slightly more 2021 Medicare Advantage plans will offer an ICL above the standard $4,130 ICL and fewer 2021 Medicare Advantage plans will offer an ICL below the 2021 standard ICL of $4,130 (see the chart below for more details).
In fact, 25 Medicare Advantage plans (MAPDs) will have an ICL above the standard ICL of $4,130 in 2021 (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 2020, 22 Medicare Advantage plans offered an ICL that was higher than the standard ICL of $4,020.
Only nine MAPDs will have an ICL below the standard ICL in 2021
as compared to 13 plans with a lower ICL in 2020. The 44 Medicare
Advantage plans with a $0 Initial Coverage Limit are Medicare-Medicaid
Plans.
| 2021 Medicare Advantage Plans Initial Coverage Limits |
|||
| ICL | Nbr of 2021 Plans |
Nbr of 2020 Plans |
Nbr of 2019 Plans |
| $0 | 44 | 44 | 50 |
| $2,750 | 1 | ||
| $3,130 | 1 | ||
| $3,500 | 2 | ||
| $3,570 | 1 | ||
| $3,595 | 1 | 1 | |
| $3,605 | 2 | ||
| $3,635 | 1 | ||
| $3,655 | 3 | ||
| $3,665 | 1 | ||
| $3,700 | 1 | ||
| $3,750 | 1 | ||
| $3,785 | 2 | ||
| $3,820 | 3,047*** | ||
| $3,835 | 1 | ||
| $3,880 | 4 | ||
| $3,885 | 2 | ||
| $3,935 | 1 | ||
| $3,980 | 5 | 1 | |
| $4,000 | 6 | ||
| $4,020 | 3,656** | ||
| $4,080 | 1 | ||
| $4,130 | 4,108* | ||
| $4,500 | 5 | 4 | |
| $5,000 | 4 | 4 | |
| $6,000 | 7 | 5 | 2 |
| $6,350 | 1 | ||
| $7,000 | 3 | 4 | 2 |
| $7,500 | 1 | ||
| $8,000 | 2 | 3 | 3 |
| $9,500 | 2 | ||
| $10,000 | 1 | 1 | |
Notes: The Medicare Advantage plans with a $0 Initial Coverage Limit are Medicare-Medicaid Plans.
*$4,130 is the 2021 standard Initial Coverage Limit
**$4,020 is the 2020 standard Initial Coverage Limit
***$3,820 is the 2019 standard Initial Coverage Limit
The Medicare Advantage plans with Initial Coverage Limits over the 2021 standard ICL of $4,130 are available in three counties in Florida.
| 2021
Medicare Advantage Plans with Increased Initial Coverage Limit (ICL) |
||
| Location | ICL | Nbr of Plans |
| Miami-Dade | $4,500 | 3 |
| Broward | $4,500 | 3 |
| Palm Beach | $4,500 | 1 |
| Miami-Dade | $5,000 | 4 |
| Miami-Dade | $6,000 | 6 |
| Broward | $6,000 | 1 |
| Miami-Dade | $7,000 | 3 |
| Broward | $7,500 | 1 |
| Miami-Dade | $7,500 | 1 |
| Palm Beach | $7,500 | 1 |
| Miami-Dade | $8,000 | 2 |
| Miami-Dade | $9,500 | 2 |
| Miami-Dade | $10,000 | 1 |
The 2021 Medicare Advantage plan information available in our 2021 Medicare Advantage plan finder (or MA-Finder) can also be found directly at: MA-Finder.com/2021.
See how each 2020 Medicare Advantage plan is changing in 2021 using our MA-Compare.com/2021.
For an example, here is a link to Summit County, OH.
Question: Will any 2021 stand-alone Medicare Part D plans have an ICL that is different from the standard?
Yes. One stand-alone 2021 Medicare Part D prescription drug plan (PDP) will have an Initial Coverage Limit that is lower than the standard $4,130 ICL. The 2021 New York EmblemHealth VIP Rx Plus (PDP) will have an ICL of $3,970 - meaning that members in this PDP, will enter the Donut Hole slightly faster than members in a Medicare Part D plan with the higher $4,130 ICL.