What Is Medigap Plan L? What You Need to Know
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Medigap Plan L is a Medicare Supplement Insurance plan that helps pay for certain out-of-pocket expenses associated with Medicare Part A and Part B coverage.
Unlike most Medigap plans, Plan L pays for only part of the cost of covered services. As a result, you’ll still have to pay some out-of-pocket costs, but the plan’s premiums are less expensive than most other Medigap alternatives.
How it works
After Medicare pays for its portion of covered services, Medigap plans help pay for the out-of-pocket costs that are left over. Medigap plans only work for beneficiaries with Original Medicare — Medicare Advantage members can’t buy a Medigap plan.
There are 10 standardized Medigap plans available in most states (except Massachusetts, Minnesota and Wisconsin, which use different standards). The plans differ in terms of coverage for services, out-of-pocket limits and premium costs.
Similar to Plan K, Medigap Plan L pays for a percentage of the services it covers. Plan L covers 75% of the cost for most covered services, so you’re still responsible for the remaining 25% out of your own pocket.
Medigap Plan L also has an out-of-pocket limit — another feature it shares only with Plan K. When you reach Plan L’s limit of $3,470 for 2023, the plan pays for 100% of its covered services until the end of the calendar year.
What Medigap Plan L covers
Medigap Plan L covers the following, according to Medicare.gov:
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.
Part A deductible (75%).
Part A hospice care coinsurance or copayment (75%).
Part B coinsurance or copayment (75%).
Skilled nursing facility care coinsurance (75%).
Blood transfusion, first three pints (75%).
Annual out-of-pocket limit of $3,470 in 2023.
What Medigap Plan L doesn’t cover
Here are the benefits Medigap Plan L doesn’t cover that are included in some other plans:
Medicare Part B excess charges (if a provider is permitted to charge more than Medicare’s approved amount and does so).
Emergency care during travel outside the U.S.
Additionally, all Medigap plans — including Plan L — sold to new Medicare members don’t cover the following:
Part B deductible (since 2020, new Medicare members can’t buy any plan that covers the Part B deductible, although existing members may own older plans that do).
Long-term care (like non-skilled care you get in a nursing home).
How much does Medigap Plan L cost?
Plan L has lower premiums than most other Medigap options as a result of its reduced coverage. While the plan is regulated by the government, the private companies that sell policies set the prices. Premiums vary according to factors including age, location and tobacco use. In a representative North Carolina ZIP code (27406), monthly premiums for a 65-year-old nonsmoker range from $59 to $250.
To find out what a Medigap Plan L policy would cost you, visit Medicare.gov.
You can get the best price and have the easiest time enrolling in a Medigap plan during your Medigap open enrollment period.
This period happens only once. It starts once you’re 65 and enrolled in Medicare Part B, and lasts for six months. (If you're still working after 65 and covered by a group employer plan that is deemed creditable coverage, your six-month period starts after you’ve ended active employment or no longer have that insurance.)
Medigap policies are cheapest and easiest to get during this open enrollment period because insurance companies aren’t allowed to factor your health or medical history into your price. After the period ends, the prices may go up or you may be denied coverage due to your health status or medical history.
In some states, insurance companies sell Medigap plans to those under 65 who are living with a disability and are eligible for Medicare. You can find more information through your State Health Insurance Assistance Program, or SHIP.
If you have questions about Medicare, visit Medicare.gov or call 800-633-4227 (TTY: 877-486-2048).
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