Medicare Supplement Insurance: Plan L
Medicare Supplement (Medigap) coverage helps cover certain costs that Original Medicare, Part A and Part B, doesn’t cover. There are up to 10 standardized plans available in most states, and Medigap Plan L is one of those 10 options.
Medigap Plan L offers partial coverage for most of its benefit categories, with the exception of the Medicare Part A hospital coinsurance benefit. This may be a more budget-friendly option for those who want some help with certain Medicare costs, but don’t want to pay high premiums for Medicare Supplement coverage. Other Medicare Supplement insurance plans may provide full (instead of partial payment) benefits in the same benefit categories, but may cost more.
How Medicare Supplement benefits work
While Medicare Supplement insurance plans may help fill in certain gaps in Original Medicare coverage, these plans aren’t meant to provide stand-alone coverage. You’ll need to remain enrolled in Original Medicare, Part A and Part B, for the rest of your Medicare benefits. If you want prescription drug coverage, you can get it through a Medicare Prescription Drug Plan, since Medicare Supplement insurance plans don’t include prescription drug benefits.
Medicare Supplement benefits don’t work with Medicare Part C (Medicare Advantage). That is, you can’t use your Medicare Supplement insurance plan to pay for costs you may have with a Medicare Advantage plan. If you enroll in a Medicare Advantage plan, you’re free to keep your Medicare Supplement insurance plan, but you won’t be able to use its benefits with your Medicare Advantage plan. Keep in mind that if you drop your Medicare Supplement insurance plan to enroll in a Medicare Advantage plan, you may be able to get it back with guaranteed issue in some situations.
For example, if you drop a Medicare Supplement policy to enroll in a Medicare Advantage plan and decide to go back to Original Medicare within a year, you have a trial right to get back the Medicare Supplement insurance plan you had before you joined the Medicare Advantage plan. If your former Medicare Supplement insurance plan isn’t available anymore, you buy any Medicare Supplement Plan A, B, C, F, K, or L that is offered in your state.
As mentioned, Medigap Plan L is just one option you may have available to you. Because Medicare Supplement insurance is available through private insurance companies, plan availability may vary by location and county. Not every insurance company in your area may offer Plan L.
Medicare Supplement insurance: Medigap Plan L benefits
As mentioned, Medigap Plan L policy offers partial coverage for a variety of benefits. This plan pays 75% of the cost for most of its covered benefits, including the following out-of-pocket expenses:
- Medicare Part A deductible
- Medicare Part B copayment or coinsurance coverage
- First three pints of blood for a covered medical procedure
- Medicare Part A hospice care coinsurance or copayment
- Skilled nursing facility (SNF) care coinsurance
Medigap Plan L provides full coverage for the following benefit:
- Medicare Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted
In addition, Medigap Plan L includes an out-of-pocket limit benefit, which may change from year to year.
Maximum out-of-pocket limit for Medigap Plan L
Medigap L is one of two Medicare Supplement insurance plans that includes a yearly out-of-pocket limit as a covered benefit.
The maximum out-of-pocket limit is $2,780 in 2019, provided that the medical expenses are for Medicare-covered services. If you’re enrolled in Plan L and your out-of-pocket expenses reach this limit (and you meet the Medicare Part B deductible), the plan then pays 100% of covered services for the remainder of the calendar year.
It’s important to note that in Original Medicare, Part A and Part B, there is no yearly maximum cap on your out-of-pocket costs. If you have a health emergency and your medical costs skyrocket, there is no limit to your medical costs in a given year. With Medigap Plan L, you’ll have peace of mind knowing that your annual costs won’t be higher than the plan’s maximum out-of-pocket limit (after meeting the deductible).
Wondering how Medigap Plan L compares to other Medicare Supplement plans in your area? Call eHealth to speak with a licensed insurance agent about your Medicare coverage options.