Original Medicare, Part A and Part B do not pay for certain costs. A Medicare Supplement (Medigap) plan will help pay for those certain costs. In most states, there are up to 10 Medigap plans that are obtainable. Medigap Plan L is one of those 10 options.
If you don’t want to pay high premiums for Medicare Supplement plans but you still need help with certain Medicare costs. Then Medicare plan L will be a more affordable option. Except for Medicare hospital coinsurance benefit, Plan L will partially pay for most of its benefit categories. Other Medigap plans may cost more because they provide full (not partial) payment benefits in the same benefit categories.
How do the Medicare Supplement benefits work?
Prescription drug benefits are not included in a Medicare Supplement insurance plan. So you will still have to get prescription drug coverage through a Medicare Prescription Drug Plan. Medicare Supplement Insurance plans are only meant to fill in certain gaps in the Original Medicare Coverage. For the rest of your Medicare benefits, you must stay enrolled in Original Medicare, Part A and Part B.
If you want to use your Medicare Supplement Benefits with Medicare Part C (Medicare Advantage), it will not work. So, if you owe any amount to a with a Medicare Advantage Plan, then you can’t use your Medicare Supplement insurance plan. However, enrolling in a Medicare Advantage Plan does not drop your Medicare Supplement insurance Plan. You just will not be able to use its benefits with your Medicare Advantage plan. Please note that if you have plans on enrolling in a Medicare advantage Plan and decide to drop your Medicare Supplement insurance plan, you may be able to get it back in some conditions with a guaranteed issue.
For instance, if you had a Medicare Supplement insurance plan prior to joining the Medicare Advantage plan, you have a trial right to get it back. This usually happens when you decide to go back to Original Medicare after enrolling in a Medicare Advantage plan. You may be able to buy any Medicare Supplement Plan (A, B, D, G, K, M, N, or L that your state offers if your former Medicare Supplement insurance plan is no longer obtainable.
Plan availability may differ by county and location and Plan L is just one option you may have accessible to you. This is because Medicare Supplement insurance is only accessible through private insurance companies. And Plan L coverage is not available through every insurance company in your area.
What are the Medigap Plan L benefits?
Medigap Plan L partially pays for a multitude of benefits. For most of the benefit coverage, this plan will pay 75% of the cost. Here are the out-of-pocket expenses it includes:
- Skilled nursing facility (SNF) care coinsurance
- Medicare Part A hospicare care copayment or coinsurance
- Medicare Part B coinsurance or copayment coverage
- The first 3 pints of blood for medical procedure coverage.
- Medicare Part A deductible
You will get full coverage from Medigap Plan L for this benefit below:
- If you exhaust your Medicare benefits, then Plan L will cover your Part A hospital and coinsurance costs for an extra 365 days
An out-of-pocket limit benefit is also included through Medigap Plan L, this is subject to change from year to year.
What is the maximum out-of-pocket limit for Medigap Plan L?
Medigap Plan L covers a yearly out-of-pocket limit as a benefit. It is only one of two Medicare Supplement insurance plans that does that.
For the services that Medicare covers, the out-of-pocket limit is $2,940 in 2020. If you pay the Medicare Part B deductible and you’re out-of-pocket expenses reach the limit as a Plan L enrollee. Then the plan covers 100% of the covered services for the rest of the calendar year.
Please be aware that there is no annual limit on your out-of-pocket costs in Original Medicare (Part A and Part B). So, there is no limit to your medical costs in a given year even if your medical costs shoot up because of a health emergency. With Medigap Plan L, you will have a limit on out-of-pocket costs, so your annual costs won’t be higher than that limit (after paying the deductible).
Want to compare and contrast other Medicare Supplement plans in your area, and how it stands to Medigap Plan L? Enter your zip code on this page to start comparing plans.