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 |
Notes: The Medicare Advantage plans with a $0 Initial Coverage Limit are Medicare-Medicaid Plans.
*$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.