Original Medicare doesn’t cover all healthcare costs. Medicare Supplement Plan L helps cover those extra costs by providing out-of-pocket limits on your healthcare spending.
Medicare Supplement Plan L is one of two Medicare supplement (Medigap) plans that include yearly out-of-pocket limits. The other is Medicare Supplement Plan K.
After you meet your yearly Part B deductible and your out-of-pocket yearly limit, Medicare Supplement Plan L pays for 100% of covered services for the rest of the year.
Keep reading to learn about the benefits, downsides, cost, and coverage for Supplement Plan L.
2024 out-of-pocket limits by plan
- Medicare Supplement Plan L: $3,530 out-of-pocket limit
- Medicare Supplement Plan K: $7,060 out-of-pocket limit
With Original Medicare (Part A hospital insurance and Part B medical insurance), there’s no cap on your annual healthcare costs. Limiting the amount of money spent on healthcare is one reason people purchase a Medicare supplement plan (Medigap).
Because Medicare Supplement Plan L has an out-of-pocket limit, choosing this supplement can help you better plan for your medical expenses. That’s because you’ll know the maximum you may have to spend in any given year for covered medical conditions.
An out-of-pocket limit may be especially beneficial if you:
- have high costs for ongoing medical care due to a chronic health condition
- want to feel prepared if faced with an unexpected and expensive medical situation
There are some downsides to consider when choosing whether to add a Medigap plan to your Medicare coverage:
- Costs: Medigap policies come with higher premium costs, which you’ll need to pay in addition to your standard Medicare premiums.
- Drug coverage: Medigap plans do not cover prescription drugs.
- No additional benefits: Medigap plans do not offer additional benefits like dental, vision, or hearing coverage.
- Enrollment restrictions: You need to enroll in a Medigap plan during the open enrollment period to avoid being subject to health-related questions. If you miss the window, you may need to pay higher premiums or be denied coverage due to health conditions.
- Variations across states: Although coverage for Medigap plans is standardized at the federal level, pricing and availability vary from state to state.
Most Medigap policies cover coinsurance after you’ve paid the deductible. Some also pay the deductible. Medicare Supplement Plan L coverage includes:
| Benefit | Percentage covered |
| 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 | 75% (first 3 pints) 95% (after first 3 pints and Part B deductible) |
| skilled nursing facility care coinsurance | 75% |
| Part B deductible | not covered |
| Part B excess charge | not covered |
| foreign travel exchange | not covered |
| out-of-pocket limit | $3,530 in 2024, with 100% of covered services for the rest of the year paid after you meet your yearly Part B deductible and your out-of-pocket yearly limit |
Because Original Medicare doesn’t cover all healthcare costs, private companies can sell supplemental insurance to Medicare recipients to help cover those extra costs.
Medigap policies follow standardized federal and state laws. However, standardization in Massachusetts, Minnesota, and Wisconsin are different. In most states, Medicare supplemental insurance plans are identified by the same letter so that Medicare Supplement Plan L cost and coverage is the same from state to state.
Eligibility for Medigap requires that you:
- have Original Medicare parts A and B
- have your own policy (your spouse requires their own separate policy)
- pay monthly premiums in addition to your Medicare premiums
You cannot have both Medicare supplemental insurance (Medigap) and a Medicare Advantage plan.
Medicare Supplement Plan L is a Medigap policy that helps cover healthcare costs not covered by Original Medicare. One of its features is setting a yearly limit on the amount of money you’ll spend out-of-pocket.
When considering whether to add a Medigap policy to your Original Medicare plan, you’ll want to review the costs and benefits for your individual health and financial needs.
You have a choice of 10 Medigap plans, each offering different levels of coverage and options. If a limit on out-of-pocket spending is important to you, Medicare Supplement Plan L may be a good option for you.