Medicare supplement Plan L is a Medigap plan, which helps pay some uncovered costs associated with Medicare Part A and Part B.
Medigap plans are Medicare supplement insurance for people with original Medicare. Plan L is one of only two Medigap plans that put an annual cap on healthcare costs.
This article discusses what Medicare supplement Plan L does and does not cover, and the associated costs. It then examines Plan L eligibility, compares Plan L with other Medigap options, and looks at when a person can switch to another plan.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare, parts A and B, does not provide 100% of a person’s healthcare costs. It has “gaps” in coverage in the form of deductibles, copays, and coinsurance. Medigap plans help fill these gaps.
The chart below shows Medigap Plan L’s percentage of coverage for various benefits.
|Part A hospice care copay or coinsurance||75%|
|Part A coinsurance and hospital costs up to an extra year’s coverage after Medicare benefits are used||100%|
|Part A deductible||75%|
|skilled nursing facility care coinsurance||75%|
|Part B copay or coinsurance||75%|
|Part B deductible||No|
|Part B excess charge||No|
|first 3 pints of blood||75%|
|foreign travel emergency care||No|
Medigap plans offer the same basic benefits across the United States with the exception of three states that standardize benefits in a different way. The three states are Minnesota, Wisconsin, and Massachusetts.
Plan L does not cover the Medicare Part B annual deductible nor emergency care costs that a person may encounter when traveling. Also, Plan L does not cover excess charges, which are the amounts a provider charges that exceed Medicare-approved amounts.
Other than the uncovered benefits specific to Plan L, there are some general uncovered benefits that apply to all Medigap plans. For example, none of the plans cover vision or hearing care, private duty nursing, or long-term care, such as non-skilled care a person receives in a nursing home.
In addition, Medigap plans do not provide prescription drug coverage. An individual with original Medicare may get this benefit from a Medicare Part D plan.
People with Plan L must pay monthly premiums, which vary among companies. The cost of the premiums also depends on whether someone receives discounts for various reasons, such as arranging payment through electronic funds transfer.
After a person pays their Part B yearly deductible and their healthcare costs exceed the annual cap of $3,110, their Plan L pays all Medicare-covered expenses for the remainder of the year.
However, regardless of whether someone exceeds the yearly cap, they must pay the monthly Part B premium that usually changes annually.
A person is eligible for a Medigap plan if they have original Medicare. In contrast, an individual with a Medicare Advantage (Part C) plan is not eligible.
In addition, Plan L does not cover emergency healthcare costs that may happen while a person is traveling. For this reason, it may not be the best choice for a person who travels frequently.
However, Plan L is one of only two Medigap plans that put a yearly cap on healthcare costs.
In general, if a person wants to switch from Plan L to another Medigap plan, they must do so during the 6 months of the Medigap open enrollment period. This period begins the month they turn 65 and enroll in Medicare Part B.
When someone wishes to change Medigap plans outside the open enrollment period, there is no guarantee an insurance company will sell a policy to them. If a company does offer to enroll a person in a plan, it may be at an increased cost.
Medicare Plan L is a Medigap plan that helps a person with original Medicare pay uncovered healthcare expenses.
It covers 100% of Medicare Part A hospital costs and coinsurance up to an additional year after someone uses up their Medicare benefits. Other benefits include 75% coverage of the Part A deductible, Part A hospice care coinsurance, and Part B coinsurance.
Although some Medigap plan options may provide greater coverage, Plan L offers a yearly cap on healthcare costs.