Updated October 14, 2019 with CMS revised landscape data.
Although, the vast majority of Medicare Advantage plans that include drug coverage (MAPDs) will continue to use
the standard defined Medicare Part D Initial Coverage Limit (ICL) ($3,820 in 2019), some 2019 MAPDs
will have an ICL that is higher or lower than the standard.
First, why is the ICL important?
The Initial Coverage Limit (ICL) is what Medicare prescription drug plans use to determine when Medicare beneficiaries enter the Donut Hole or Coverage Gap. If a Medicare Advantage plan (MAPD) follows the standard defined Medicare Part D plan parameters, then plan members will enter the 2019 Donut Hole when their total negotiated retail prescription drug costs reach $3,820, a $70 increase over the 2018 standard Initial Coverage Limit of $3,750. This means, if your Medicare Part D plan or Medicare Advantage plan follows the standard defined Initial Coverage Limit and you purchase medications with an average retail value of less than $318 per month, you will NOT enter the 2019 Donut Hole.
What does it mean when my plan has a higher ICL?
Since the Initial Coverage Limit is based on the negotiated retail value of your medications (the portion of your drug costs that you pay PLUS the portion paid by your Medicare Part D plan), if your plan has an ICL higher than the standard ICL, you will be able to buy more medications before reaching the 2019 Donut Hole or Coverage Gap.
What does it mean when my plan has a lower ICL?
If your Medicare Advantage plan has an ICL under $3,820, you will be able to buy fewer medications before reaching the 2019 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 paid counts toward TrOOP or getting out of the Donut Hole, not the portion paid by your Medicare Part D plan.)
2019 ICL Landscape:
As in past years, the vast majority of 2019 Medicare Advantage plans will have the standard Initial Coverage Limit. As compared to 2018, more 2019 Medicare Advantage plans will offer an ICL above the standard $3,820 ICL and fewer 2019 Medicare Advantage plans will offer an ICL below the 2019 standard ICL of $3,820 (see the chart below for more details).
In fact, only 11 MAPDs will have an ICL below the standard ICL in 2019 as compared to 17 plans with a lower ICL in 2018. The 50 Medicare Part D plans with a $0 Initial Coverage Limit are Medicare-Medicaid Plans.
In 2018, 10 Medicare Advantage plans offered an ICL that was higher than the standard ICL of $3,750 — with the highest ICL reaching $8,000. In 2019, 25 Medicare Advantage plans will have an ICL above the standard ICL of $3,820 with the highest ICL once again being $8,000.
| 2019 Medicare Advantage Plans Initial Coverage Limits |
|||
| ICL | Nbr of 2019 Plans |
Nbr of 2018 Plans |
Nbr of 2017 Plans |
| $0 | 50 | 54 | 62 |
| $3,010 | 1 | ||
| $3,025 | 1 | ||
| $3,100 | 2 | ||
| $3,130 | 1 | ||
| $3,200 | 1 | ||
| $3,310 | 3 | ||
| $3,390 | 3 | ||
| $3,400 | 1 | ||
| $3,450 | 1 | ||
| $3,490 | 2 | ||
| $3,500 | 2 | 7 | |
| $3,515 | 1 | ||
| $3,530 | 1 | ||
| $3,540 | 2 | ||
| $3,545 | 2 | ||
| $3,560 | 1 | ||
| $3,590 | 1 | 3 | |
| $3,595 | 1 | 2 | |
| $3,600 | 1 | 1 | |
| $3,605 | 2 | ||
| $3,635 | 1 | ||
| $3,655 | 3 | ||
| $3,700 | 1 | 2,305*** | |
| $3,750 | 2,615** | ||
| $3,820 | 3,047* | ||
| $4,000 | 6 | 5 | 7 |
| $4,500 | 3 | 2 | |
| $5,000 | 9 | 1 | 1 |
| $6,000 | 2 | 1 | |
| $7,000 | 2 | 1 | 2 |
| $8,000 | 3 | 2 | 1 |
*$3,820 is the 2019 standard Initial Coverage Limit
**$3,750 is the 2018 standard Initial Coverage Limit
***$3,700 is the 2017 standard Initial Coverage Limit
With some positive news for Miami-Dade County residents
The Medicare Advantage plans with Initial Coverage Limits over the 2019 standard ICL of $3,820 are only available in Miami-Dade County, FL.
| 2019
Medicare Advantage Plans with Increased Initial Coverage Limit (ICL) |
||
| Location | ICL | Nbr of Plans |
| Miami-Dade | $4,000 | 5 |
| Broward | $4,000 | 1 |
| Miami-Dade | $4,500 | 3 |
| Broward | $4,500 | 1 |
| Palm Beach | $4,500 | 1 |
| Miami-Dade | $5,000 | 5 |
| Orange | $5,000 | 1 |
| Broward | $5,000 | 1 |
| Palm Beach | $5,000 | 1 |
| Hillsborough | $5,000 | 1 |
| Miami-Dade | $6,000 | 2 |
| Miami-Dade | $7,000 | 2 |
| Miami-Dade | $8,000 | 3 |
The 2019 Medicare Advantage plan information available in our 2019 Medicare Advantage plan finder (or MA-Finder) can also be found directly at: MA-Finder.com/2019.
See how each 2018 Medicare Advantage plan is changing in 2019 using our MA-Compare.com/2019.
For an example, here is a link to Summit County, OH.