Fewer Medicare Advantage plans will offer a variation on the standard Initial Coverage Limit in 2021
Although, the vast majority of Medicare Advantage plans with drug coverage
will use the standard defined 2021 Medicare Part D Initial Coverage Limit
(ICL) of $4,130, a few 2021 MAPDs
will have an ICL that is higher or lower than the standard. And one stand-alone Medicare Part D plan
in New York will have a lower ICL.
Question: Why is the ICL important?
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 standard defined Medicare Part D plan parameters,
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 Initial Coverage Limit 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?
Question: What does it mean when my plan has a lower 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
medications before reaching the 2021 Donut Hole or
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
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
|2021 Medicare Advantage Plans
Initial Coverage Limits
|$2,750|| ||1|| |
|$3,130|| || ||1|
|$3,500|| || ||2|
|$3,570|| ||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|| || |
|$4,000|| || ||6|
|$4,020|| ||3,656**|| |
|$4,080||1|| || |
|$4,130||4,108*|| || |
|$7,500||1|| || |
|$9,500||2|| || |
Notes: The Medicare Advantage plans with a $0 Initial Coverage Limit are
*$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
Here is some positive news...
The Medicare Advantage plans with Initial Coverage Limits over the 2021 standard ICL of $4,130 are available in three counties in Florida
Medicare Advantage Plans
with Increased Initial Coverage Limit (ICL)
||Nbr of Plans
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?
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 with this PDP, you will enter the Donut Hole slightly faster than a Medicare Part D plan with the higher $4,130 ICL.