Medigap Plan L helps provide coverage for some out-of-pocket healthcare expenses from Original Medicare, which comprises of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Plan L is one of 10 standardized Medicare Supplement plans, and offers one of the lowest premiums. As each standardized Medicare Supplement plan differs in coverage, learn if Plan L is the best Medigap choice for your needs.
How Medigap Plan L Works
Medigap is offered by Medicare-approved insurance companies, and only works with Original Medicare to help cover Medicare’s coinsurance, premiums, and other out of pocket costs. Depending on your health needs and frequency of care, the premium cost of a Medigap plan may be significantly lower than the cost of your out-of-pocket expenses from Medicare. For example, Medigap Plan L can help cover up to 75% of your Part A deductible for a hospital service. In this way, Medigap could help make your Medicare costs more affordable.
There are 10 standardized Medigap plans available in most states, including Plan L: Plans A, B, C, D, F, G, K, L, M, and N. However, residents of Wisconsin, Minnesota, and Massachusetts have different standardized options. In addition, all individual states may have their own regulations for Medigap options, so it is generally a good idea to check with your state’s Department of Insurance for specifics once you have narrowed down your preferred Medigap plans.
Each plan has its own coverage amounts and limitations, including an annual out-of-pocket limit. After you have reached the limit amount, Medigap Plan L would cover the remainder of the costs for the rest of the year.
Note that all Medigap plans only work with Original Medicare. Those with Medicare Advantage plans, or Medicare Part C, are not eligible for Medigap.
What Medicare Supplement Plan L Covers
|Benefits||Plan L||Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan|
|Plan M||Plan N|
|Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||75%||Yes||Yes||Yes||Yes||Yes||Yes||50%||Yes||100% coinsurance; but copays may still apply|
|Part A hospice care coinsurance or copayment||75%||Yes||Yes||Yes||Yes||Yes||Yes||50%||Yes||Yes|
|Part A deductible||75%||Not covered||Yes||Yes||Yes||Yes||Yes||50%||50%|||
|Part B deductible||Not covered||Not covered||Not covered||Yes||Not covered||Yes||Not covered||Not covered||Not covered||Not covered|
|Part B excess charge||Not covered||Not covered||Not covered||Not covered||Not covered||Yes||100%||Not covered||Not covered||Not covered|
|Out-of-pocket limit||$3,470 in 2023||N/A||N/A||N/A||N/A||N/A||N/A||$6,940 in 2023||N/A||N/A|
|Blood (first three pints)||75%||Yes||Yes||Yes||Yes||Yes||Yes||50%||Yes||Yes|
|Skilled nursing facility care coinsurance||75%||Not covered||Not covered||Yes||Yes||Yes||Yes||50%||Yes||Yes|
|Foreign travel exchange up to plan limits||Not covered||Not covered||Not covered||80%||80%||80%||80%||Not covered||80%||80%|
Medicare Plan L tends to have one of the lowest premiums of all Medigap options. This is because unlike some of the other Medigap plans, it partially covers costs instead of completely covering them. For example, Medicare Supplement Plan L covers 75% of Original Medicare’s Part B coinsurance. This means if your Part B coinsurance totaled $500, Plan L would help cover $375 of it, leaving you to cover the remaining $125 out of pocket.
Every Medigap plan, including Plan L, pays for Part A coinsurance and hospital costs after Medicare benefits are used up for up to 365 days of additional care. Plan L also covers:
- 75% of the cost of the first three pints of blood if required for medical care
- 75% of Part A hospice care coinsurance
- 75% of skilled nursing facility care coinsurance
- 75% of Part A deductible
What Medicare Supplement Plan L Does Not Cover
Medigap Plan L does not cover any Part B deductibles or Part B excess charges. Plan L also does not provide coverage for medical care while traveling outside of the United States.
Medicare Supplement Plan L Eligibility
Anyone currently enrolled in Original Medicare can choose a Medigap plan, but if you have a Medicare Advantage plan, you cannot purchase a Medigap plan. The basic criteria for Medicare eligibility are to be 65 years old or older, or those younger than 65 may be eligible for criteria if they have certain disabilities or End Stage Renal Disease.
Plan L vs. Other Medigap Options
Medigap Plan L tends to have one of the lowest premiums of all the lettered Medigap plans. This is because most other Medigap plans offer 100% coverage for out-of-pocket healthcare expenses not covered by Original Medicare, while Plan L provides 75% coverage. Unlike many other Medigap options, Plan L also does not provide coverage for emergency healthcare while traveling. However, these limitations make it more affordable.
Plan L may be ideal for someone with few healthcare needs, but still wants to limit potential out-of-pocket healthcare costs if they need help to manage a new health condition or illness.
Medigap Plan L vs. Medigap Plan K
Medigap Plan L and Plan K are the two Medigap plans that cover less than 100% of out-of-pocket healthcare costs with Original Medicare. As a result of the lower coverage levels, premiums for Plan L and Plan K are typically lower than they may be for other Medigap plans.
While Medigap Plan L covers 75% of out-of-pocket healthcare costs for Original Medicare recipients, Plan K provides coverage for 50% of out-of-pocket healthcare costs. In addition, Medigap Plan K has an out-of-pocket maximum that’s more than twice as much as Plan L’s out-of-pocket maximum. Neither plan provides coverage for emergency medical care while traveling.
Plan L vs. Medicare Advantage
Medicare Advantage plans and Medigap plans are incompatible, in that you cannot have both at the same time. Medigap plans are supplemental to Original Medicare, and exist to help with the costs of Medicare rather than offering healthcare benefits of their own. On the other hand, a Medicare Advantage plan, sometimes called Part C or MA Plan, is an alternative to Original Medicare coverage provided by private insurance companies. These plans replace Original Medicare and offer healthcare benefits and coverages through a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), or HMO Point-of-Service (HMO POS) plan.
Medicare Supplement plans may have higher premiums than Medicare Advantage plans, depending on the plan you choose. This is because some Medicare Advantage plans have $0 premiums, which means the insured person pays nothing for the coverage, though they must still pay Part B premiums. Medicare Advantage plans also tend to offer more benefits than Original Medicare, such as Part D prescription drug coverage and vision health coverage.
However, because Medicare Advantage plans utilize health networks, options for care providers may be more limited than with Original Medicare. MA plans require beneficiaries to only seek the services of in-network physicians, specialists, and facilities, while those with Original Medicare and Medigap Plan L may seek service from any provider that accepts Medicare. If you want the freedom to see any healthcare provider approved by Medicare, a Medicare Supplement plan may be the right choice.
How to Enroll in Medigap Plan L
You can sign up for Medigap plans at any time, but outside of your Individual Initial Enrollment Period, insurers are allowed to deny applications due to pre-existing health conditions.
Individual Initial Enrollment Period
- When: A 7-month period that begins three months before you turn 65, includes the month you turn 65, and three months after.
- What You Can Do: Enroll in Medicare Part A and Part B, as well as Medigap
Enrolling in a Medigap plan during your individual initial enrollment period allows you to forgo answering health questions on your Medigap application. During this time, all Medigap options in your state must be made available to you. Outside of this window, you may apply at any time to enroll in Medigap if you have Original Medicare, but insurers may charge a significantly higher rate or deny your application altogether.