You probably know by now that your Medicare health insurance does not cover everything when it comes to your expenses. That’s where Medicare Supplement Plans come in. Today we’ll talk specifically about Medicare Supplement Plan L. Medicare Supplement Plan L is also commonly called Medigap Plan L, since Medigap plans attempt to fill the gaps in Original Medicare’s coverage.
In a nutshell, Medigap plans are administered by third party insurance companies under the supervision of the United States federal government. There are 10 standardized Medigap Plans. Each of these vary in terms of cost and availability based on your location, your age, your medical condition, and a host of other factors.
Medigap Plan L provides partial coverage for several Medicare benefit categories. This makes it an option for patients who need certain services but who are looking for a plan that doesn’t break the bank with high monthly premium prices. Plan L is not comprehensive. It is recommended to research other available Medigap plans as well to find which one best fit your needs. However, other plans will typically cost more than Plan L.
It’s crucial to understand that Plan L and other Medigap offerings are not intended to be used as your sole means of insurance. You will need to keep your original Medicare coverage (Part A or Part B) both for the benefits and because it is a requirement to enroll in Plan L. It is also worth noting that Medigap plans do not cover prescription drug benefits. They also do not interact well with Medicare Part C (sometimes called Medicare Advantage). This means that any co-payment or co-insurance costs you may incur as a result of your Medicare Advantage plan will not be covered or offset by Medigap Plan L. However, you are allowed to carry both simultaneously if you wish.
Plan L’s benefits typically pay 75% of the cost of its covered services. These services include:
- Medicare Part deductible
- Medicare Part B co-insurance and co-payments
- Medicare Part A hospice co-insurance and co-payments
- skilled nursing facility co-insurance
- the first three pints of blood for an approved medical procedure
Additionally, Medigap Plan L provides full coverage for Medicare Part A hospital fees and co-insurance for up to a year after original Medicare benefits are depleted.
Medigap Plan L also features a yearly out-of-pocket limit. This may result in significant savings if you have an unexpected medical emergency or you need ongoing medical care. Think of Plan L’s out-of-pocket limit as the maximum amount you will ever have to pay for medical services in a year’s time. The 2016 out-of-pocket limit is $2,480. So regardless of how many medical procedures or office visits you require this year, the most you would ever pay would be $2,480 (provided of course that the services are all covered by Plan L). This out-of-pocket limit works well as a supplement to Medicare Part A or Part B, neither of which feature an out of pocket limit. As long as you are enrolled in Plan L and you have already met the Medicare Part B deductible, the Medigap plan will pay 100% of the costs of additional covered services for the rest of the year.
Due to the large number of third-party companies who provide Medigap services, it is beyond the scope of this document to list them all. We can, however, connect you with an insurance agent to help you learn if Medigap Plan L meets your individual needs, and to find out if you qualify for enrollment.