Health & DietMedicare Plan L: What's Covered and What's Not?

Medicare Plan L: What’s Covered and What’s Not?


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Medicare Plan L: What’s Covered and What’s Not?

The Medicare L Supplement Plan is one of two Medigap plans with an annual cap on self-expenditure.

Medigap plans, also called Medicare supplement plans, are offered by private companies to help cover some health care costs that the original Medicare didn’t pay for.

This plan is standardized in 47 states. In Massachusetts, Minnesota, and Wisconsin, there are different standardization policies.

To be eligible for a Medigap plan, including Plan L, you must have Medicare Part A (hospital insurance) and Medicare Part B (health insurance).

Read on to learn more about Medicare Plan L coverage and more.

What does the Medicare Supplement Plan L cover?

Medigap Plan L policies help cover many gaps in your original Medicare coverage, such as Part A deductions.

Below are things that are covered and not covered:

Profit Coverage percentage
Part A coin insurance and hospital fees for up to an additional 365 days after Medicare benefits expire 100%
Part A is deductible 75%
Part A hospital care coinsurance or copayment 75%
blood (3 liters first)/(after first 3 liters) 75%/100%
coinsurance skilled care facility maintenance 75%
Part B coinsurance or copayment 75%
Part B is deductible not covered
Part B overcharge not covered
overseas travel exchange not covered

Who is closed?

If you buy a Medigap Plan L policy, it will only cover you. If your spouse is eligible for Medicare and needs Medigap coverage, they must purchase a separate policy.

What is not covered by Medicare Plan L?

Medigap plans, including Plan L, do not cover outpatient prescriptions. If you want this coverage, you must purchase Medicare Part D.

The Medigap plan, including Plan L, does not cover dental, hearing, or vision care. You can get coverage in these areas with Medicare Advantage plans, some of which also include Medicare Part D.

Remember: you cannot have a Medigap plan and a Medicare Advantage plan.

Not covered

The following services and treatments are not covered by Medicare Plan L:

  • outpatient retail prescription
  • dental
  • hearing
  • vision

What is the out-of-pocket limit?

In 2021, the out-of-pocket limit for Plan L is $3,110. Once you meet your annual Part B deduction ($203 in 2021) and your annual out-of-pocket limit, Medigap will pay 100 percent of covered services for the remainder of the year.

Why do people choose Medicare Supplement Plan L?

A popular feature of the Medigap Plan L is the annual limit on self-expenditure. Only two of the 10 Medigap plans offer this feature:

  • Medicare Additional Plan L: $3,110 out-of-pocket limit in 2021
  • Medicare K Supplement Plan: $6,220 out-of-pocket limit in 2021

With original Medicare and eight other Medigap plans (A, B, C, D, F, G, M, N), there’s no limit to your annual healthcare costs.

Due to spending limits, purchasing a Plan L can help you identify your maximum health spending for the year. This may be especially useful if you:

  • expect high costs for ongoing medical care, such as with existing chronic health conditions
  • worry about the potential financial drain if you have to experience an expensive health situation

Medicare Plan L is one of Medigap’s offerings to help cover some expenses that the original Medicare didn’t pay for. One of the popular features of this plan is that it limits your annual costs associated with Medicare.

Coverage not covered by Medigap Plan L includes vision, hearing, dentistry, and prescription drugs.

Medicare plan options and costs may change annually.

John Bailey
John Bailey
John Bailey is an industry expert within the healthcare and gaming software landscapes. He works at Chetu Inc., Sunrise, Fla., a custom software development provider and thought-leader within the IT community. He offers commentary on changing tides within the healthcare and gaming industries.


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