Although, the vast majority of Medicare Advantage plans with drug coverage (
MAPDs) will use
the standard defined 2020 Medicare Part D
Initial Coverage Limit (ICL) of $4,020, some 2020 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.)
First, why is the ICL important?
Medicare
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,
then plan members will enter the 2020 Donut Hole when their total negotiated retail prescription drug costs reach
$4,020, a
$200 increase
over the 2019 standard Initial Coverage Limit of $3,820.
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 $335 per month, you will
NOT enter the
2020 Donut Hole.
What does it mean when my plan has a higher 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 2020 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 $4,020, you will be able to buy
fewer medications before reaching the 2020 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.
2020 Medicare Advantage plan ICL Landscape:
As compared to 2019, more 2020 Medicare Advantage plans will offer an ICL above the standard $4,020 ICL and fewer 2020 Medicare Advantage plans will offer an ICL below the 2020 standard ICL of $4,020 (see the chart below for more details).
In fact, 22 Medicare Advantage plans (MAPDs) will have an ICL
above the standard ICL of $4,020 in 2020 (all located in Florida) — with the
highest ICL increasing to $10,000 (this means plan members can buy formulary drugs with a retail value up to $10,000 before reaching the Coverage Gap). In 2019, 25 Medicare Advantage plans offered an ICL that was higher than the standard ICL of $3,820 — with the highest ICL reaching $8,000.
Only 13 MAPDs will have an ICL below the standard ICL in 2020
as compared to 11 plans with a lower ICL in 2019. The 44 Medicare
Advantage plans with a $0 Initial Coverage Limit are Medicare-Medicaid
Plans.
2020 Medicare Advantage Plans
Initial Coverage Limits |
ICL |
Nbr of
2020 Plans
|
Nbr of
2019 Plans
|
Nbr of
2018 Plans |
$0 |
44 |
50 |
54 |
$2750 |
1 |
|
|
$3010 |
|
|
1 |
$3130 |
|
1 |
|
$3200 |
|
|
1 |
$3450 |
|
|
1 |
$3500 |
|
2 |
7 |
$3515 |
|
|
1 |
$3545 |
|
|
2 |
$3570 |
1 |
|
|
$3590 |
|
|
1 |
$3595 |
1 |
1 |
2 |
$3600 |
|
|
1 |
$3605 |
|
2 |
|
$3635 |
|
1 |
|
$3655 |
|
3 |
|
$3665 |
1 |
|
|
$3700 |
|
1 |
|
$3,750 |
1 |
|
2,615*** |
$3785 |
2 |
|
|
$3,820 |
|
3,047** |
|
$3835 |
1 |
|
|
$3880 |
4 |
|
|
$3980 |
1 |
|
|
$4000 |
|
6 |
5 |
$4,020 |
3,656* |
|
|
$4500 |
4 |
|
|
$5000 |
4 |
|
|
$6000 |
5 |
2 |
1 |
$6350 |
1 |
|
|
$7000 |
4 |
2 |
1 |
$8000 |
3 |
3 |
2 |
$10000 |
1 |
|
|
Notes: The Medicare Advantage plans with a $0 Initial Coverage Limit are Medicare-Medicaid Plans.
*$4,020 is the 2020 standard Initial Coverage Limit
**$3,820 is the 2019 standard Initial Coverage Limit
***$3,750 is the 2018 standard Initial Coverage Limit
Here is some positive news...
The Medicare Advantage plans with Initial Coverage Limits over the 2020 standard ICL of $4,020 are available in three counties in
Florida.
2020
Medicare Advantage Plans
with Increased Initial Coverage Limit (ICL) |
Location |
ICL |
Nbr of Plans |
Miami-Dade | $4,500 | 3 |
Broward | $4,500 | 3 |
Palm Beach | $4,500 | 2 |
Miami-Dade | $5,000 | 4 |
Miami-Dade | $6,000 | 4 |
Broward | $6,000 | 1 |
Palm Beach | $6,000 | 1 |
Miami-Dade | $6,350 | 1 |
Miami-Dade | $7,000 | 4 |
Miami-Dade | $8,000 | 3 |
Miami-Dade | $10,000 | 1
|
The 2020 Medicare Advantage plan information available in our 2020 Medicare Advantage plan finder (or
MA-Finder) can also be found directly at:
MA-Finder.com/2020.
See how each 2019 Medicare Advantage plan is changing in 2020 using our
MA-Compare.com/2020.
For an example, here is a link to
Summit County, OH.
Will any 2020 stand-alone Medicare Part D plans have an ICL that is different from the standard?
Yes. One stand-alone 2020 Medicare Part D prescription drug plan (PDP) will have an Initial Coverage Limit that is lower than the standard $4,020 ICL. The 2020 New York
EmblemHealth VIP Rx Plus (PDP) will have an ICL of $3,800 - meaning that with this PDP, you will enter the Donut Hole slightly faster than a Medicare Part D plan with the higher $4,020 ICL.