Medicare Supplement Plan L is one of the two Medigap plans with a yearly cap on out-of-pocket spending.
Medigap plans, also called Medicare supplement plans, are offered by private companies to help cover some healthcare costs not paid for by original Medicare.
These plans are standardized in 47 states. In Massachusetts, Minnesota, and Wisconsin, there are different standardization policies.
To qualify for any Medigap plan, including Plan L, you must have Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Read on to learn more about Medicare Plan L coverage and more.
A Medigap Plan L policy helps cover many of the gaps in your original Medicare coverage, such as the Part A deductible.
Below are things that are and aren’t covered:
| Benefit | Coverage percentage |
|---|---|
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up | 100% |
| Part A deductible | 75% |
| Part A hospice care coinsurance or copayment | 75% |
| blood (first 3 pints)/(after first 3 pints) | 75%/100% |
| skilled nursing facility care coinsurance | 75% |
| Part B coinsurance or copayment | 75% |
| Part B deductible | not covered |
| Part B excess charges | not covered |
| foreign travel exchange | not covered |
Who’s covered?
If you purchase a Medigap Plan L policy, it will only cover you. If your spouse is eligible for Medicare and needs Medigap coverage, they’ll need to purchase a separate policy.
Medigap plans, including Plan L, don’t cover outpatient prescriptions. If you want this coverage, you must purchase Medicare Part D.
Medigap plans, including Plan L, don’t cover dental, hearing, or vision. You can get coverage in these areas with a Medicare Advantage plan, some of which also include Medicare Part D.
Keep in mind: You can’t have both a Medigap plan and a Medicare Advantage plan.
Not covered
The following services and treatments aren’t covered by Medicare Plan L:
- outpatient retail prescriptions
- dental
- hearing
- vision
In 2021, the out-of-pocket limit for Plan L is $3,110. Once you meet your yearly Part B deductible ($203 in 2021) and your out-of-pocket yearly limit, Medigap will pay for 100 percent of covered services for the rest of the year.
A popular feature of Medigap Plan L is the yearly cap on out-of-pocket spending. Only two of the 10 Medigap plans offer this feature:
- Medicare Supplement Plan L: out-of-pocket limit of $3,110 in 2021
- Medicare Supplement Plan K: out-of-pocket limit of $6,220 in 2021
With original Medicare and the other eight Medigap plans (A, B, C, D, F, G, M, N), there’s no cap on your yearly out-of-pocket healthcare costs.
Because of the out-of-pocket limit, purchasing Plan L can help you identify your maximum out-of-pocket health expenses for the year. This may be especially useful if you:
- expect high costs for ongoing medical care, such as with an existing chronic health condition
- are worried about a potential financial drain if you should experience an expensive health situation
Medicare Plan L is one of the Medigap offerings to help cover some costs not paid by original Medicare. One popular feature of this plan is capping your annual Medicare-related out-of-pocket costs.
Coverage not included with Medigap Plan L includes vision, hearing, dental, and prescription drugs.
Medicare plan options and costs are subject to change each year.