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Medigap - Plan L
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Important Points
Plan L is one of the ten uniform Medigap plans available.
Plan L offers 75% coverage on most Medicare benefits, but also has a maximum out-of-pocket limit to cap your annual costs.
Plan L does not cover the Part B deductible, Part B excess charges, or foreign travel emergency.
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Plan L offers lower premiums if you share in costs
Medigap Plan L is another version of a cost-sharing Medigap policy. This plan will typically be less expensive since you agree to share in some of the costs. When you enroll in Medigap Plan L, the insurance company will pay 75% of your covered medical expenses on most items, and you will pay the other 25%. Additionally, you agree to pay the Medicare Part B deductible and any excess charges on your own.
Medigap Benefits - Plan L
Medicare Part A Coinsurance & Hospital Costs
(Up to an additional 365 days after Medicare benefits are used)
75%
Medicare Part B Coinsurance or Copayment
75%
Blood (First 3 Pints)
75%
Part A Hospice Care Coinsurance or Copayment
75%
Skilled Nursing Facility Coinsurance
75%
Medicare Part A Deductible
Medicare Part B Deductible
Medicare Part B Excess Charges
Foreign Travel Emergency (up to plan limits)
Out-of-Pocket: Maximum Cap Protection
A Medigap Plan L policy includes a cap on your out-of-pocket spending. This is called your out-of-pocket limit or maximum. Medicare sets this limit each year, and in 2025, the limit for Plan L is $3,530. So if in any one calendar year, your spending reaches $3,530 in Medicare-approved covered expenses, then the Medigap Plan L policy pays the rest for the remainder of the year. This cap makes it easier to agree to share in 25% of the costs on the items listed because you know that even in a year of bad health, you won't have more exposure than the maximum limit.
Medigap Plan L - Example
Mr. Martinez purchases a Medigap Plan L policy. He has surgery to remove his gall bladder. If Medicare's approved amount for this surgery is $2,000, then his Plan L will pay $1,500, and Mr. Martinez will be responsible for the other $500.
This amount is also tallied by his Medigap Insurance company against his out-of-pocket maximum, and if his costs in that calendar year go over $3,530 in 2025, then his Medigap Plan L will pay 100% of any Medicare-approved expenses for the remainder of the year.
His Plan L also functions similarly for his share of outpatient expenses under Part B, except that he is responsible for the once-annual Part B deductible.
Let's assume that Mr. Martinez has already paid his deductible earlier in the year when he had a regular doctor's appointment. Later in the year, his doctor orders a CT scan. Medicare will pay 80% of the cost for the CT scan, and his Medigap Plan L will pay 75% of what remains. If the CT scan cost is $1,000, then Medicare pays $800, his Medigap Plan L policy pays $150 (75% of the remaining $200), and Mr. Martinez must pay the $50 difference.
Quotes for Medigap Plan L
In most states, each insurance company can decide which Medigap plans it will offer to consumers. Many of them carry popular plans such as Plan F or Plan G, but not as many companies offer Medigap Plan L. Working with one of our trusted insurance agents that specialize in Medicare insurance products won't cost you a dime and can help to minimize the amount of time and effort you put into researching companies and prices.
Since only a few companies offer Medigap Plan L, we can help you get quotes from the companies that do. Contact Mohring Insurance Services LLC online to request a quote!
Key Points
Plan L usually has a lower monthly premium, but only covers 75% of the cost of most Medicare services.
Plan L covers 75% of the cost of approved benefits, but does not cover the Part B deductible, Part B excess charges, or foreign travel emergency.
Once you hit the maximum out-of-pocket cap, your cost will be covered 100% for the rest of the year.
At Mohring Insurance Services LLC, we are happy to offer assistance with Medicare when you choose to enroll. Give us a call at (866) 440-1885, or to schedule a free consultation, click the link below:
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