While many Medigap plans either pay or don’t pay for an out-of-pocket expense, Plan L often pays 75% of an expense. The table below illustrates this benefit tendency within Plan L (for example, see “Medicare Part A Deductible” and “Copayment or Co-Insurance Fee for Medicare Part A Hospice Care”).
|Plan L Coverage|
|Medicare Part A Deductible||75% coverage|
|Medicare Part B Deductible||No coverage|
|Medicare Part B “Excess Charges”*||No coverage|
|Copayment or Co-Insurance Fee for Medicare Part B services||75% coverage|
|Part A Co-Insurance Fees & Hospital Costs for up to 365 days after Original Medicare Benefits are Exhausted||100% coverage|
|Cost of first 3 Pints of Blood||75% coverage|
|Copayment or Co-Insurance Fee for Medicare Part A Hospice Care||75% coverage|
|Co-Insurance Fees for Skilled Nursing Facility Care||75% coverage|
|Foreign Travel Medical Emergency Coverage (up to plan limits)||No Coverage|
|Annual Limit on Enrollee Out-of-Pocket Expenses?||$2,470|
Plan L has an annual out-of-pocket limit of $2,470. Once an enrollee’s out-of-pocket costs reach this amount, Plan L fully pays for all remaining out-of-pocket costs for covered services until the beginning of a new calendar year. Plan L is one of only two Medigap Plans that have an annual limit on Medicare out-of-pocket costs. Plan K is the other Medicare Supplement insurance plan with an annual out-of-pocket limit.
Plan L may be attractive to Medicare beneficiaries who want to protect themselves from catastrophic out-of-pocket costs but don’t mind the prospect of paying $2,470 in a year if they have heavy healthcare use.
If you desire coverage for all of the out-of-pocket costs listed in the above table, you may want to investigate Plan F.
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