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 2018 Donut Hole when their total negotiated retail prescription drug costs reach an Initial Coverage Limit of $3,750, a $50 increase over the 2017 standard Initial Coverage Limit of $3,700. 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 $312 per month, you will not enter the 2018 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, if your plan has an ICL higher than the standard ICL, you will be able to buy more medications before reaching the 2018 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 $3,750, you will be able to buy fewer medications before reaching the 2018 Donut Hole or Coverage Gap. (Remember, when you purchase a drug with a $100 retail cost and you only pay $10, the $100 retail cost is counted toward reaching your ICL. The $10 out-of-pocket cost is counted toward TrOOP or getting out of the Donut Hole.)
2018 ICL Landscape:
As in past years, the vast majority of 2018 Medicare Advantage plans will have the standard Initial Coverage Limit. As compared to 2017, fewer 2018 Medicare Advantage plans will offer an ICL above the standard $3,750 ICL and fewer 2018 Medicare Advantage plans will offer an ICL below the 2018 standard ICL of $3,750 (see the chart below for more details).
In fact, fewer (only 17) MAPDs will have an ICL below the standard ICL in 2018 as compared to 21 plans with a lower ICL in 2017.
In 2017, 13 Medicare Advantage plans offered an ICL that was higher than the standard ICL of $3,700 - with the highest ICL reaching $8,000. (The 2018 Simply More (HMO) and Simply Level (HMO SNP) will have an $8,000 ICL.) In 2018, only 17 Medicare Advantage plans will have an ICL above the standard ICL of $3,750 with the highest ICL reaching $8,000.
| 2018 Medicare Advantage Plans Initial Coverage Limits |
|||
| ICL | Nbr of 2018 Plans |
Nbr of 2017 Plans |
Nbr of 2016 Plans |
| $0 | 54 | 62 | 66 |
| $2,550 | 1 | ||
| $2,750 | 1 | ||
| $2,790 | 1 | ||
| $2,800 | 2 | ||
| $2,830 | 1 | ||
| $2,950 | 8 | ||
| $2,980 | 1 | ||
| $3,000 | 4 | ||
| $3,025 | 1 | ||
| $3,050 | 1 | ||
| $3,100 | 2 | 5 | |
| $3,310 | 3 | ||
| $3,150 | 3 | ||
| $3,200 | 1 | 3 | |
| $3,210 | 4 | ||
| $3,220 | 1 | ||
| $3,250 | 1 | ||
| $3,310 | 2,232*** | ||
| $3,390 | 3 | ||
| $3,400 | 1 | ||
| $3,490 | 2 | ||
| $3,500 | 7 | 2 | |
| $3,530 | 1 | ||
| $3,540 | 2 | ||
| $3,560 | 1 | ||
| $3,590 | 1 | 3 | |
| $3,600 | 1 | 1 | |
| $3,640 | 1 | ||
| $3,700 | 2,305** | ||
| $3,750 | 2,615* | ||
| $4,000 | 5 | 7 | 7 |
| $4,500 | 2 | ||
| $5,000 | 1 | 1 | 3 |
| $6,000 | 1 | 1 | |
| $7,000 | 1 | 2 | 2 |
| $8,000 | 2 | 1 | 2 |
**$3,700 is the 2017 standard Initial Coverage Limit
***$3,310 is the 2016 standard Initial Coverage Limit
With some positive news for Miami-Dade County residents
The Medicare Advantage plans with Initial Coverage Limits over the 2018 standard ICL of $3,750 are only available in Miami-Dade County, FL.
| 2018
Medicare Advantage Plans with Increased Initial Coverage Limit (ICL) |
||
| Location | ICL | Nbr of Plans |
| Miami-Dade County, FL | $4,000 | 5 |
| Miami-Dade County, FL | $5,000 | 1 |
| Miami-Dade County, FL | $6,000 | 1 |
| Miami-Dade County, FL | $7,000 | 1 |
| Miami-Dade County, FL | $8,000 | 2 |
See how each 2017 Medicare Advantage plan is changing in 2018 using our MA-Compare.com/2018.
For an example, here is a link to Summit County, OH.