Medicare Plan L is a type of Medicare supplement insurance, or Medigap. The costs of the plan can vary by location.
If a person has original Medicare, they may also have a Medigap plan to help with out-of-pocket expenses.
Different plans are available in different areas, and each could have different costs.
Individuals with Medicare Advantage are unable to enroll in a Medigap 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.
Medigap Plan L is one of 10 Medigap plans available in the United States that a person can have alongside original Medicare.
Private insurance companies administer these plans, but not every company sells Medigap policies in every area.
That said, every policy must follow federal and state rules that specify that each lettered plan must have the same basic benefits.
Plan providers do not have to offer every Medigap plan, but if they do, they must offer Medigap plans A and C or F.
Beginning January 1, 2020, Medicare does not allow any Medigap plan to cover the Part B deductible. This means that Medigap plans C and F are not available to anyone who is new to Medicare after January 1, 2020.
Some Medigap Plan L benefits include the following:
| Benefit | Coverage |
|---|---|
| Part A deductible | 75% |
| Part A coinsurance and hospital costs | 100% |
| Part A coinsurance or copayment for hospice | 75% |
| Part A coinsurance for skilled nursing facility care | 75% |
| Part B coinsurance or copayment | 75% |
| blood, first 3 pints | 75% |
| out-of-pocket limit | $3,110 |
Medigap Plan L does not cover the following:
- Part B deductible
- Part B excess
- foreign travel emergency care
Medigap Plan L costs depend on several factors, including where a person lives, the plan they buy, and the company administering the policy.
Medicare has a helpful tool that a person can use to search Medigap plans available in their area. With this tool, individuals can enter their zip code, and the results will show all plans currently available in their state.
Costs for Medigap Plan L policies include a premium and out-of-pocket limit. How plan providers set premiums varies by state, but there are three calculation methods:
- Community-rated: Also known as no-age-rated, this refers to when the insurer charges the same premium for people of all ages.
- Issue-age-rated: This refers to when the company charges premiums based on a person’s age when they first buy the policy. Premiums do not go up as people get older.
- Attained-age-rated: This refers to when premiums depend on a person’s current age. They may pay more as they get older.
The monthly premium is usually the only associated cost of a Medigap plan. A person must pay this amount alongside their other Medicare costs, such as the premiums for parts A, B, and D.
Out-of-pocket limit
Plan L is one of two Medigap policies with an out-of-pocket limit, making it a popular feature. The plan pays 100% of covered services for the rest of the calendar year after a person meets their Part B deductible and other out-of-pocket limits.
The only other plan to offer this is Medigap Plan K, which has an out-of-pocket limit of $6,220.
The table below compares the 2021 benefits of the 10 Medigap plans. Find the key below.
- Yes: This indicates that the plan covers 100% of the benefit.
- No: This indicates that the plan does not cover the benefit.
- %: This indicates the percentage the benefit covers.
- N/A: This indicates that the benefit does not apply to the plan.
| What is the benefit? | A | B | C | D | F | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A deductible | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part A coinsurance and hospital costs | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part A coinsurance or copayment for hospice | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A coinsurance for skilled nursing facility care | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part B deductible | No | No | Yes | No | Yes | No | No | No | No | No |
| Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes (apart from a $20 copay for doctor visits and $50 for emergency room visits) |
| Part B excess charge | No | No | No | No | Yes | Yes | No | No | No | No |
| blood, first 3 pints | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| foreign travel exchange | No | No | 80% | 80% | 80% | 80% | No | No | 80% | 80% |
| out-of-pocket limit | N/A | N/A | N/A | N/A | N/A | N/A | $6,220 | $3,110 | N/A | N/A |
Medigap policies help with some Medicare costs, but a person may also be eligible for additional help with their out-of-pocket healthcare costs. The sections below will provide some more information on these other sources of support.
Medicaid
Medicaid is a joint state and federal program that helps individuals with limited incomes pay for medical costs. A person can check their eligibility on the Medicaid website.
Extra Help
The Extra Help program helps with the costs associated with prescription medications. If a person has limited incomes and resources, they may be eligible for Extra Help.
Program of All-Inclusive Care for the Elderly
This joint Medicare and Medicaid program helps people with limited incomes meet their healthcare needs through a community healthcare team, allowing them to keep their independence and stay at home.
Medicare savings programs
Medicare savings programs are state-run Medicare programs that help pay health plan costs, such as premiums, deductibles, coinsurance, and copayments.
Supplemental Security Income
Supplemental Security Income is a monthly benefit available from Social Security for people with limited incomes. It is not the same as retirement or disability benefits.
Medicare Plan L is a Medigap plan. The 10 Medigap plans are each identified by a letter. Private health insurance companies administer Medigap plans, and they must follow Medicare coverage rules.
Medigap Plan L is one of two plans that have an out-of-pocket limit.
People can compare each Medigap plan’s benefits to be sure that the plan meets their healthcare needs.