- Medicare Supplement Plan L is one of the various Medigap plan options.
- The out-of-pocket maximum for Plan L is $3,110 in 2021.
- Plan L doesn’t have a deductible.
- Your premiums for Plan L will depend on where you live, the company you purchase Plan L from, and your health.
Medicare supplement plans, also known as Medigap plans, help you cover some of the health insurance costs that would normally fall to you. These can include coinsurance, copayments, and deductibles.
Plan L is a Medigap plan that offers this coverage without its own deductible. It covers 100 percent of your costs for some Medicare-approved services and 75 percent of the cost for others.
Read on to learn more about Plan L, including costs and coverage.
When you use original Medicare, you’re responsible for costs like deductibles and coinsurance amounts.
Medicare supplement plans, like Plan L, can help reduce those costs. That means you’ll pay less out of pocket when you receive care.
You will pay an additional premium for Plan L. The premium will depend on:
- where you live
- the company you purchase the plan from
- other individual factors
You’ll need to pay that premium along with your premiums for original Medicare.
Medicare Supplement Plan L doesn’t have a deductible. However, you’re still responsible for some of your original Medicare deductible before this plan will pay.
You’ll need to cover the full Part B deductible and 25 percent of the Part A deductible.
Plan L does offer an out-of-pocket-maximum.
An out-of-pocket-maximum is the most you’ll pay for deductibles, coinsurance, copayments, and other costs before your plan starts covering 100 percent of them.
In 2021, the Plan L out-of-pocket-maxim is $3,110. Premiums don’t count toward the maximum.
Plan L covers 100 percent of the cost of your Part A coinsurance and hospital costs for an additional 365 days over Medicare’s limit.
Plan L also covers 75 percent of the cost of:
- Part A deductible. With Part A, there isn’t one set deductible for the calendar year. Instead, you pay the deductible for each benefit period. Benefit periods are based on inpatient admissions to a hospital. You can have multiple benefits periods in a single calendar year.
- Part A copayments for hospice care. Medicare covers 100 percent of hospice care you receive in your home — with one exception. You’ll pay a copayment of no more than $5 for each medication you take. With Plan L, you’d pay no more than $1.25.
- Part A coinsurance for skilled nursing facility (SNF) care. You’ll pay a daily coinsurance fee from days 21 through 100 of your SNF stay under Part A. On day 101, you’re responsible for 100 percent of the costs. Using Plan L, you’d pay much less for coinsurance on days 21 through 101 and 70 percent of the full cost each day after.
- Part B coinsurance costs. The Part B coinsurance is typically 20 percent of the Medicare-approved cost of an item or service. With Plan L, you’d only pay 5 percent.
- Your first three pints of blood for a covered medical procedure. You normally don’t pay for pints of blood since they’re often donated to hospitals and medical centers. However, when there is a cost, you’re normally responsible for the first three pints under Medicare Part A. With Plan L, you’d only be responsible for 75 percent of this cost.
Plan L will pay 100 percent of the above costs if you hit the out-of-pocket-maximum.
However, there a few costs that Plan L doesn’t cover, including:
- Part B deductible. Only Plan C and Plan F cover this cost. These plans aren’t available if you became eligible for Medicare on or after January 1, 2020. If you were eligible before this time, you may still keep or buy these plans.
- Part B excess charges. Excess charges are costs billed to you when a service costs more than Medicare will pay. For example, if a lab test costs $115 but the Medicare-approved amount is $100, you can sometimes be billed for the excess $15. Plan L doesn’t cover this charge.
- Foreign travel. Some Medigap plans do cover your care in foreign countries, but Plan L does not.
Plan L is one of 10 Medigap plans. Different plans have different coverage and costs. If Plan L doesn’t offer the coverage you’re looking for, another Medigap plan might fit your needs better.
If you’re eligible for Medicare, you can enroll in a Medicare supplement plan. However, there a few things you should be aware of:
- Medigap plans are different in Massachusetts, Minnesota, and Wisconsin. You’ll have different plan options if you live in one of these three states. This means you can’t enroll in the standard Plan L.
- You must be enrolled in both parts of original Medicare. You need to be enrolled in both Part A and Part B before you can enroll in a Medigap plan.
- You’re only guaranteed acceptance to a Medigap plan when you first enroll in Medicare. During your initial 6-month enrollment window, you can’t be turned down for any Medigap plan, and you’ll be guaranteed the best rate. If you apply at a later time, you could be subject to a medical exam before a plan is approved. In some cases, your application could be denied or charged a much higher rate.
- You can’t have a Medicare Advantage plan and a Medigap plan at the same time. If you have a Medicare Advantage plan and want to enroll in Medigap, you’ll need to drop your Advantage plan and return to original Medicare first.
Medicare supplement plans are sold by private companies. Medigap plans are standardized, which means Plan L covers the same costs no matter what company you purchase it from.
You can search for companies offering Plan L and other Medigap plans in your area using the Medicare website.
Using the search tool, you can enter your ZIP code to see plans and prices in your area. You can also enter your age and gender and select whether you smoke to get more accurate prices.
Medicare Supplement Plan L can help cover the costs of using original Medicare. There’s no deductible for Plan L, though you will be responsible for the entire Part B deductible and 25 percent of the Part A deductible.
Plan L has an out-of-pocket maximum. Once you reach the maximum, the plan will cover 100 percent of your coinsurance and copayment costs.