Medicare is a government-run health insurance program for the elderly and people with disabilities. Medigap, on the other hand, is a Medicare supplement program offered by private companies. As you may know, Original Medicare (Parts A and B) has out-of-pocket charges such as deductibles and copayments. Medigap plans aim to help with some of these costs, with different plans covering different portions of your Medicare expenses.
Private insurance companies offer a total of 10 Medigap plans, including Plan L. This plan is one of two that has a yearly out-of-pocket limit (the other being Medigap Plan K), but it covers Original Medicare costs to a lesser extent than most Medigap plans. As a result, understanding Plan L and its “cost-sharing” dynamic may seem complicated, but it doesn’t have to be with the right advice.
Read through the article to learn what Medigap Plan L covers, who’s eligible to sign up for it, and how much it costs. We’ll also help you decide if Plan L is the best option for you and your family. Making informed choices about your health should be a top priority, especially if you’re almost 65 or enrolled in Original Medicare but don’t feel happy with your current coverage. Keep reading.
What Is Medigap Plan L, And What Does It Cover?
Medigap Plan L is a type of health insurance that supplements your Original Medicare coverage. Like other Medigap plans, Plan L is standardized, meaning that regardless of which company you buy from, each policy must give the same basic benefits.
Medigap Plan L covers 100% of:
- Part A coinsurance and hospital costs up to 365 days after Medicare benefits are used up
- Covered services for the rest of the year after you meet your out-of-pocket yearly limit of $3,310 and your Part B deductible
And 75% of:
- Part A deductible
- Medicare Part A hospice care coinsurance or copayment
- Part B coinsurance or copayment
- The first three pints of blood required for a transfusion each year
- Skilled nursing facility care coinsurance
What Does Medigap Plan L Not Cover?
Medigap Plan L covers several expenses, but mainly up to 75%; you’ll be responsible for paying the other 25%. In addition, Plan L doesn’t cover the Part B deductible or the excess charge. The Part B deductible is the amount you must pay out-of-pocket each year before your Medigap plan pays its share of covered expenses. The Part B deductible for 2022 is $233.
Doctors who don’t agree to accept the Medicare-approved amount as their payment may charge you an additional 15% of what Medicare is willing to pay; this is also known as the excess charge. You should always ensure your doctor accepts assignment before scheduling an appointment, as Plan L won’t cover said excess charges.
Another benefit that Plan L doesn’t include is prescription drugs. If you aren’t on Medicare Part D, you’ll still need to pay for your prescription drugs. Lastly, Medigap Plan L doesn’t cover long-term care, dental care, eye exams, or foreign travel emergency care.
Medigap Plan L Eligibility
If you have Original Medicare, you’re eligible for a Medigap plan. Medicare covers people over 65, people with disabilities under 65, and those with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). You can access Part A or Original Medicare without paying premiums at 65 if you meet the following criteria:
- Social Security or the Railroad Retirement Board provides you with retirement benefits.
- You are eligible for Social Security or Railroad Retirement payments but haven’t yet filed for them.
- You or your spouse worked for the government and received Medicare coverage.
If you are under the age of 65, you may be eligible for Part A coverage without having to pay a premium if:
- For the past 24 months, you’ve been eligible for Social Security or Railroad Retirement Board disability benefits.
- You’re on dialysis or have had a kidney transplant.
A Medigap plan isn’t available to people with Medicare Advantage or employer-sponsored health coverage. While most Medigap policies require you to live in the plan’s service area, some provide nationwide coverage.
When Can I Sign Up For Medigap Plan L?
Open Enrollment Period
During your six-month Medigap Open Enrollment Period (OEP), you may be able to enroll in a Medicare Supplemental Plan L policy. Your OEP starts the first day of the month after you turn 65 and enroll in Medicare Part B. Regardless of your health status, you normally have the choice of purchasing any Medigap plan during this enrollment time.
If you skip this period or wait until after your OEP to apply for a Medigap plan, you may have to undergo a medical exam or underwriting. Your application could be denied based on any pre-existing health issues.
Outside Of The Open Enrollment Period
Under some circumstances, such as losing your health coverage, you have the right to enroll in a Medigap plan outside your Open Enrollment Period. You can enroll in any Medigap plan available in your state if you have a “guaranteed issue” right, regardless of your health status. However, you may have to pay a larger premium for the plan.
How To Enroll In Medigap Plan L?
Before choosing a Medigap policy, consider the benefits you’d like to have based on your current and future health needs. Once you’ve decided this, you should research to find the plan that best suits your preferences. Find out which insurance companies offer the plan you’re interested in and contact them to learn more about their terms and conditions, including coverage details and costs.
Keep in mind that not all insurers offer all types of Medigap plans. After deciding on a plan and an insurance company, you can apply. To enroll, you’ll need to fill out a form. The questions included are primarily about personal and medical information but never related to your family history. Once the company approves coverage, you’ll have to pay a monthly premium.
Medigap Plan L Costs
Several aspects determine monthly Medigap rates, such as the cost of living in your state. The monthly premium for Medigap Plan L in Connecticut in 2022 can range from $185 to $469. You should speak to a Medicare expert to get an accurate estimate of what you’ll be paying.
Private insurance companies will set their rates for Medigap plans based on any of 3 different methods:
- Community-rated (also called “no age-rated”): Everyone with a Medigap policy pays the same monthly cost regardless of age. Premiums may rise because of inflation and other circumstances, but they won’t increase due to age.
- Issue age-rated (also called “entry-age rated)”: The premium depends on your age at the time you purchase (or are “issued”) the Medigap coverage. Premiums are lower for younger buyers and won’t increase as you become older, yet they may increase as a result of inflation.
- Attained-age-rated: The premium is calculated based on your current age (the age you have “attained”); therefore, as you become older, your premium will rise. These policies may appear the cheapest initially, but they can quickly become the most costly. Other circumstances may also cause attained-age-rated premiums to rise.
The Benefits Of Having Medigap Plan L
One of the main benefits of Medigap Plan L is that it can help you save money on your overall healthcare costs. Plan L covers some expenses that Original Medicare doesn’t cover. While it has higher monthly premiums than other options like Medicare Advantage, the out-of-pocket costs are considerably lower. Medigap plans also work in any state, and you don’t need a provider network.
Another benefit of Medigap Plan L is that it gives you comprehensive coverage. You’ll feel confident knowing that you’re more covered in the event of an accident or illness.
Is Medigap Plan L The Best Option For You And Your Family?
There’s no one-size-fits-all answer to this question, as only you can decide the best Medigap plan for you and your family according to your health needs and budget. Consider how much you’re willing to pay and how much you’re likely to need concerning medical care. Once you’ve done that, you can compare Medigap plans and prices to find the best option for you.
Plan L is a good option for many people due to its yearly out-of-pocket limit. If you have a chronic health condition that requires continuing medical care, or you want to be ready for potentially costly unanticipated medical crises, the yearly out-of-pocket limit may be very convenient.
Nesso Senior Benefits – We Help You Find The Right Health Insurance Plan
At Nesso Senior Benefits, we’re a team of Medicare experts in Connecticut who help our clients navigate the complexities of Medicare and keep them updated on new information. Our partners analyze your unique needs to identify how you can best benefit from Medicare’s resources. Choosing a health insurance plan can be confusing and overwhelming, but we’re here to assist you.
We have extensive knowledge and experience in all aspects of Medicare, and we’ll deliver a customized plan making sure you’re heard, seen, and supported. Our top priority is to help you make informed decisions for the years ahead. At the Nesso Group, we aim to relieve you of any needless worry while always putting your best interests first.