Getting Care in Emergencies: What You Should Know
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Medicare Supplement Plan L
What is Medicare Supplement Plan L?
Medigap Plan L offers partial coverage for most of its benefit categories, with the exception of the Medicare Part A hospital coinsurance benefit. This may be a more budget-friendly option for those who want some help with certain Medicare costs, but don’t want to pay high premiums for Medicare Supplement coverage. Other Medicare Supplement insurance plans may provide full (instead of partial payment) benefits in the same benefit categories, but may cost more.
Medicare Supplement Insurance: Medigap Plan L benefits
As mentioned, Medigap Plan L policy offers partial coverage for a variety of benefits. This plan pays 75% of the cost for most of its covered benefits, including the following out-of-pocket expenses:
- Medicare Part A deductible
- Medicare Part A hospice care coinsurance or copayment
- First three pints of blood for a covered medical procedure
- Medicare Part B copayment or coinsurance coverage
- Skilled nursing facility (SNF) care coinsurance
Medigap Plan L provides full coverage for the following benefit:
- Medicare Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted
- In addition, Medigap Plan L includes an out-of-pocket limit benefit, which may change from year to year.
Maximum out-of-pocket limit for Medigap Plan L
Medigap L is one of two Medicare Supplement insurance plans that includes a yearly out-of-pocket limit as a covered benefit.
The maximum out-of-pocket limit for 2020 is $ 2,940, provided that the medical expenses are for Medicare-covered services. If you’re enrolled in Plan L and your out-of-pocket expenses reach this limit (and you meet the Medicare Part B deductible), the plan then pays 100% of covered services for the remainder of the calendar year.
It’s important to note that in Original Medicare, Part A and Part B, there is no yearly maximum cap on your out-of-pocket costs. If you have a health emergency and your medical costs continue to climb, there is no limit to your medical costs in a given year. With Medigap Plan L your annual costs won’t be higher than the plan’s maximum out-of-pocket limit (after meeting the deductible).
The best time for beneficiaries to enroll in Medicare Supplement plan is during their Medicare Supplement Open Enrollment Period, which is not the same for everyone.
This period begins on the first day of the first month that you are both age 65 or older and enrolled in Medicare Part B, and lasts for six months. During this time, private insurance carriers may not use medical underwriting to assess a beneficiary’s health condition.
This means that if you’re enrolled in Medicare Part A and Part B and live within a Medigap plan’s service area, you can enroll in that Medigap plan without fear of being denied coverage or charged higher premiums based on a pre-existing health condition (although waiting periods may apply).
*Medigap plans do not include prescription drug benefits; if you’re enrolled in Original Medicare and want coverage for your medications, you should enroll in a stand-alone Medicare Prescription Drug Plan.
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