Medicare Supplement Plan L


Medigap Plan L is a Medicare supplement insurance plan that provides coverage for certain medical expenses not covered by Original Medicare. It offers a slightly different level of coverage compared to other Medigap plans, with the goal of reducing your out-of-pocket costs.

With Medigap Plan L, you will be responsible for paying a portion of your healthcare expenses, including Medicare Part A coinsurance and hospital costs, Medicare Part B coinsurance or copayment, and blood expenses. The plan covers 75% of your Part A hospice care coinsurance or copayment, as well as 75% of skilled nursing facility care coinsurance.

Similar to other Medigap plans, Medigap Plan L also has an out-of-pocket limit ($3.530 for 2024). Once you reach this limit in annual out-of-pocket expenses, the plan will cover 100% of your covered services for the rest of the year. This feature provides some financial protection and helps you manage your healthcare costs.

Medigap Plan L may be a suitable option if you are looking for a lower-cost plan and are willing to share a larger portion of your medical expenses. However, it's important to carefully consider your healthcare needs and budget to determine if this plan meets your coverage preferences. Remember to review the specific benefits of Medigap Plan L and compare them with your individual healthcare requirements before making a decision.

Below is a comprehensive list of the covered services provided by Medicare Supplement Plan L, which include benefits under Medicare Part A, Medicare Part B, and other areas:

MEDICARE PART A - HOSPITAL SERVICES - PER BENEFIT PERIOD


HOSPITALIZATION
Semi-private room & board, general nursing and miscellaneous services and supplies

ServiceWho pays what?
First 60 daysMedicare pays: All cost but $1,632
Plan pays: 75% of Part A Deductible ($1,224)
Member pays[*]: 25% of Part A Deductible ($408)
61st thru 90th dayMedicare pays: All cost but $408/day
Plan pays: 75% of cost ($306/day)
Member pays[*]: 25% of cost ($102/day)
91st day and after (While using 60 lifetime reserve days)Medicare pays: All cost but $816/day
Plan pays: 75% of cost ($612/day)
Member pays[*]: 25% of cost ($204/day)
Once lifetime reserve days are used; additional 365 daysMedicare pays: Nothing
Plan pays: 75% of Medicare-eligible expenses
Member pays[*]: 25% of Medicare-eligible expenses
Beyond the additional 365 daysMedicare pays: Nothing
Plan pays: Nothing
Member pays[*]: All cost


SKILLED NURSING FACILITY CARE
You must meet Medicare’s requirements, including having been in a hospital for at least three days, and enter a Medicare approved facility within 30 days after leaving the hospital.

ServiceWho pays what?
First 20 daysMedicare pays: All cost
Plan pays: Nothing
Member pays[*]: Nothing
21st thru 100th dayMedicare pays: All but $204/day
Plan pays: Up to 75% (Up to $153/day)
Member pays[*]: Up to 25% (Up to $51/day)
101st day and afterMedicare pays: Nothing
Plan pays: Nothing
Member pays[*]: All cost


BLOOD

ServiceWho pays what?
First three pintsMedicare pays: Nothing
Plan pays: 75% of all cost
Member pays[*]: 25% of all cost
Additional amountMedicare pays: All cost
Plan pays: Nothing
Member pays[*]: Nothing


HOSPICE CARE
You must meet Medicare's requirements, including a doctor's certification of terminal illness.

ServiceWho pays what?
Hospice CareMedicare pays: All but very limited
copayment/ coinsurance for outpatient
drugs and inpatient respite care
Plan pays: 75% of Medicare copayment and
coinsurance
Member pays[*]: 25% of Medicare copayment and
coinsurance

MEDICARE PART B - MEDICAL SERVICES - PER CALENDAR YEAR


MEDICAL EXPENSES
In or out of the hospital and outpatient hospital treatment, such as physician's services, inpatient and outpatient medical services and surgical services, physical and speech therapy, diagnostic tests, durable medical equipment.

ServiceWho pays what?
Part B DeductibleMedicare pays: Nothing
Plan pays: Nothing
Member pays[*]: $240 (Part B Deductible)
Part B CoinsuranceMedicare pays: 80%
Plan pays: %15 of all cost
Member pays[*]: 5% of all cost
Part B Excess Charges
(above Medicare approved
amounts)
Medicare pays
Plan pays: Nothing
Member pays[*]: All cost


CLINICAL LABORATORY SERVICES

ServiceWho pays what?
Test for diagnostic lab services  Medicare pays: All cost
Plan pays: Nothing
Member pays[*]: Nothing


BLOOD

ServiceWho pays what?
First three pintsMedicare pays: All cost
Plan pays: Nothing
Member pays[*]: Nothing
Additional amount (First $226 of
Medicare approved amounts)
Medicare pays: Nothing
Plan pays: Nothing
Member pays[*]: $240 (Part B deductible)
Remainder of Medicare approved amountsMedicare pays: 80%
Plan pays: 15% of all cost
Member pays[*]: 5% of all cost

MEDICARE PARTS A & B - MEDICAL SERVICES - PER CALENDAR YEAR


HOME HEALTH CARE
Medicare approved services

ServiceWho pays what?
Medically necessary skilled care
services and medical supplies/
Durable medical equipment
(First $226 of Medicare approved amounts)
Medicare pays: Nothing
Plan pays: Nothing
Member pays[*]: $240 (Part B deductible)
61st thru 90th dayMedicare pays: 80%
Plan pays: 15% of all cost
Member pays[*]: 5% of all cost

OTHER BENEFITS


FOREIGN TRAVEL
Medically necessary emergency care services beginning during the first 60 days of each trip outside the United States

ServiceWho pays what?
First $250 each calendar
year/Remainder of charges
Medicare pays: Nothing
Plan pays: Nothing
Member pays[*]: All cost

Other Medicare Supplement Plans

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