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 beneficiaries enter the 2016 Donut Hole when their total negotiated retail prescription drug costs reach an Initial Coverage Limit of $3,310, a $350 increase over the 2015 standard Initial Coverage Limit of $2,960. 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 $276 per month, you will not enter the 2016 Donut Hole.
A higher ICL: Since the Initial Coverage Limit is based on the negotiated retail value of your medications, if your plan has an ICL higher than the standard ICL, you will be able to buy more medications before reaching the 2016 Donut Hole or Coverage Gap.
A lower ICL: If your Medicare Advantage plan has an ICL under $3,310, you will be able to buy fewer medications before reaching the 2016 Donut Hole or Coverage Gap.
2016 ICL Landscape:
As compared to 2015, fewer 2016 Medicare Advantage plans will offer an ICL above the standard $3,310 ICL and more 2016 Medicare Advantage plans will offer an ICL below the 2016 standard ICL of $3,310. See chart below. In fact, 37 MAPDs will have an ICL below the standard in 2016 as compared to only 13 in 2015.
In 2015, 28 Medicare Advantage plans offered an ICL that was higher than $2,960 - with the highest ICL reaching $10,000. (The 2015 Leon Medical Centers Health Plans - Leon Cares (HMO) that had a $10,000 ICL has reduced its ICL to $4,000 for 2016.) In 2016, only 17 Medicare Advantage plans will have an ICL above the standard ICL of $3,310 with the highest ICL reaching $8,000.
| 2016 Medicare Advantage Plans Initial Coverage Limits |
||
| ICL | Nbr of 2016 Plans |
Nbr of 2015 Plans |
| $1,980 | 1 | |
| $2,490 | 1 | |
| $2,500 | 1 | |
| $2,550 | 1 | |
| $2,650 | 3 | |
| $2,675 | 2 | |
| $2,690 | 1 | |
| $2,750 | 1 | 1 |
| $2,790 | 1 | |
| $2,800 | 2 | 2 |
| $2,830 | 1 | |
| $2,880 | 1 | |
| $2,950 | 8 | |
| $2,960 | 2,172** | |
| $2,980 | 1 | |
| $3,000 | 4 | 5 |
| $3,050 | 1 | |
| $3,100 | 5 | |
| $3,150 | 3 | |
| $3,200 | 3 | 2 |
| $3,210 | 4 | |
| $3,220 | 1 | |
| $3,250 | 1 | 1 |
| $3,310 | 2,232* | |
| $3,500 | 2 | 1 |
| $4,000 | 7 | 2 |
| $5,000 | 3 | 8 |
| $6,000 | 1 | 3 |
| $7,000 | 2 | 5 |
| $8,000 | 2 | |
| $10,000 | 1 | |
**$2,960 is the 2015 standard Initial Coverage Limit
The Medicare Advantage plans with increased Initial Coverage Limits are found in only four (4) counties across the nation. The majority of these plans are found in Miami-Dade County, FL.
| 2016
Medicare Advantage Plans with Increased Initial Coverage Limit (ICL) |
||
| Location | ICL | Nbr of Plans |
| Maricopa County, AZ | $3,500 | 2 |
| Pinal County, AZ | $3,500 | 2 |
| Miami-Dade County, FL | $4,000 | 6 |
| Broward County, FL | $4,000 | 1 |
| Miami-Dade County, FL | $5,000 | 3 |
| Miami-Dade County, FL | $6,000 | 1 |
| Miami-Dade County, FL | $7,000 | 2 |
| Miami-Dade County, FL | $8,000 | 2 |
The 2016 Medicare Advantage plan information available in our 2016 Medicare Advantage plan finder (or MA-Finder) can also be found directly at: MA-Finder.com/2016.
See how each 2015 Medicare Advantage plan is changing in 2016 using our MA-Compare.com/2016.
Example: Summit County, OH.