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 $3,310, 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:
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Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.
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Part A deductible (75%).
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Part A hospice care coinsurance or copayment (75%).
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Part B coinsurance or copayment (75%).
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Skilled nursing facility care coinsurance (75%).
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Blood transfusion, first three pints (75%).
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Annual out-of-pocket limit of $3,310.
What Medigap Plan L doesn’t cover
Here are the benefits Medigap Plan L doesn’t cover that are included in some other plans:
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Medicare Part B excess charges (when a provider charges you more than Medicare’s approved amount).
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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:
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 California ZIP code (92589) in 2022, monthly premiums for a 65-year-old nonsmoker range from $89 to $138.
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, which starts when you turn 65 and enroll in Medicare Part B. During this six-month period, insurers can’t consider your medical history or current health when pricing your policy.
After the period ends, it never happens again, and companies might deny coverage or charge you more based on your health status or medical history.
If you have questions about Medicare, visit Medicare.gov or call 800-633-4227 (TTY: 877-486-2048).
