Medicare Supplement Plan L | Medigap Plan L | Coverage & Details

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Medicare Supplement Plan L
Medigap Plan L is a less popular Medicare Supplement Plan due to the reduced coverage and minimal cost savings as compared with many other Medicare Supplement Plans. Medicare Supplemental Plan L has a cost-sharing component that makes it initially attractive to some folks, however by the time the cost/benefit ratio is factored in, the Plan L becomes less favorable.

Due to the fact that Medicare Supplement Prices are based on geographic location, it is possible the Medicare Plan L may be favorable in your area (concerning price), however it is important that you check the rates of multiple companies and compare the Plan L with other popular plans, like Medicare Supplement Plan F, or Medicare Supplement Plan G.

Many people forget that Medigap Plans are completely regulated by Medicare to include the same coverage and benefits--there is no difference between companies other than price. You should speak with an independent insurance broker who will be able to help you compare different companies unbiased and also help you with the enrollment process.

Below is a coverage chart for Medicare Medigap Plan L benefits. It will help you understand the coverage and cost-sharing functions of the Plan L.

Medigap Plan L | Part A Coverage MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD
* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. **With Plan L, you will pay one-fourth of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $2,400 each calendar year. However, this limit does NOT include charges from your provider that exceed Medicare approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.
HOSPITALIZATION: Semi-private room and board, general nursing and miscellaneous services and supplies.
Services		Medicare Pays	Plan Pays	You Pay
First 60 days		All but $1,184	$888 (75% of Part A Deductible)	$296 (25% of Part A Deductible)
61st through 90th day		All but $296 a day	$296 a day	$0
91st day and after:
While using 60 lifetime reserve days		All but $592 a day	$592 a day	$0
Once lifetime reserve days are used:
Additional 365 days		$0	100% of Medicare Eligible Expenses	$0**
Beyond the Additional 365 days		$0	$0	All Costs
SKILLED NURSING FACILITY CARE: You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.
Services	Medicare Pays		Plan Pays	You Pay
First 20 days	All approved amounts		$0	$0
21st through 100th day	All but $148 a day		Up to $111 per day (75% of $148 per day)	Up to $37 per day (25% of $148 per day)
101st day and after	$0		$0	All costs
BLOOD:
Services	Medicare Pays		Plan Pays	You Pay
First 3 pints	$0		70%	25%
Additional amounts	100%		$0	$0
HOSPICE CARE: You must meet Medicare's requirements including a doctor's certification of terminal illness.
Services	Medicare Pays		Plan Pays	You Pay
Hospice care	All but very limited copayment / coinsurance for out-patient drugs and inpatient respite care		75% of copayment/ coinsurance	25% of copayment/ coinsurance
**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

Medigap Plan L | Part B Coverage MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR
Once you have been billed $147 of Medicare-Approved amounts for covered services your Medicare Part B Deductible will have been met for the calendar year. **With Plan L, you will pay one-fourth of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $2,400 each calendar year. However, this limit does NOT include charges from your provider that exceed Medicare approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.
MEDICAL EXPENSES: In or Out of the Hospital and Outpatient Hospital Treatment, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.
Services	Medicare Pays	Plan Pays	You Pay
First $147 of Medicare Approved Amounts	$0	$0	$147 (Part B Deductible)
Remainder of Medicare Approved Amounts	Generally 80%	Generally 10%	Generally 10%
Part B Excess Charges (Above Medicare Approved Amounts)	$0	$0	All costs; and they do not count toward out-of-pocket limit of $2,400
BLOOD:
Services	Medicare Pays	Plan Pays	You Pay
First 3 pints	$0	50%	50%
Next $147 of Medicare Approved Amounts	$0	$0	$147 (Part B Deductible)
Remainder of Medicare Approved Amounts	Generally 80%	Generally 15%	Generally 5%
CLINICAL LABORATORY SERVICES:
Services	Medicare Pays	Plan Pays	You Pay
Tests for Diagnostic Services	100%	$0	$0

 

MEDICARE PARTS  A & B
HOME HEALTH CARE: Medicare Approved Services.
Services	Medicare Pays	Plan Pays	You Pay
Medically necessary skilled care services and medical supplies	100%	$0	$0
Durable medical equipment:
First $147 of Medicare Approved Amounts	$0	$0	$147 (Part B Deductible)
Remainder of Medicare Approved Amounts	80%	15%	5%

 

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