However, is Medigap Plan L really the right choice for you? How can you determine if you’re eligible for its coverage, and what alternatives are available if you’re not? In this article, we discuss the benefits, the drawbacks, and, of course, the eligibility surrounding Plan L to help you decide if it’s the right plan for you–and what to do in case it’s not.
What is Medigap Plan L?
Medigap Plan L is a cost-sharing Medicare supplement plan that helps pay for some of the costs that original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles.
With supplementary Medigap plans first being launched in 1992, Plan L joins Plans A, B, C, D, F, G, K, M, and N as an additional way for beneficiaries to cover out-of-pocket costs. Specifically, alongside covering 75% of most covered services, Plan L also covers the Plan A deductible to further reduce the cost of hospital stays.
The law requires that private insurers offer standardized Medigap Plan policies with comparable benefits. These baseline benefits will be offered regardless of the insurance company that is chosen, although there can be differences in cost.
Lastly, there are exceptions to Medigap plan standardizations in three states: Massachusetts, Wisconsin, and Minnesota. These states have created different Medigap policies.
The Benefits of Medigap Plan L
Standard Medicare–parts A and B–do not provide 100% coverage of an eligible person’s healthcare costs. Therefore, Plan L is one available option that can cover these “gaps” via deductibles, coinsurance, and copays.
The Drawbacks of Medigap Plan L
While its coverage is impressive, all Medigap plans – including Plan L – sold to new Medicare members do not cover the following:
- Prescription drugs
- Long-term care
- Dental care
- Vision care
- Private-duty nursing
- Hearing aids
- Routine foot care
It also does not cover the Plan B deductible since, as of 2020, new Medicare members cannot purchase any plan that covers the Plan B deductible. If you are an existing Medicare member dating back prior to 2020, however, you may be exempt from this condition.
Who is Eligible for Medigap Plan L?
To be eligible for Medigap Plan L, you must first be enrolled in Original Medicare Plans A and B.
Other requirements include:
- You must also be 65 years old or older
- You must be a resident of the state in which you are applying for coverage
- You must undergo medical underwriting if applying outside of Open Enrollment or a Special Enrollment Period (in the majority of states)
The majority of seniors will automatically enroll in Medicare Plan A at age 65, with some also automatically enrolling in Medicare Plan B.
How to Know if Medigap Plan L is Right For You
Plan L can be a great choice for those looking for cost savings on their healthcare costs. However, it does not cover the Plan B deductible, prescription drugs, long-term care, dental care, vision care, private-duty nursing, hearing aids, or routine foot care that some seniors may require.
If you need coverage for any of these services, you may want to consider another Medigap plan. It’s important to compare the different plans available to you before making a decision.
However, if you are seeking a cost-sharing supplement plan with low out-of-pocket maximums, Plan L is a suitable option. Those who are eligible can enroll during its open enrollment period: this period is the six-month duration that begins when you turn 65 and enroll in Plan B, as well as the 6 months after.
If Plan L is enrolled in during this period, you be given guaranteed issue rights to ensure that:
- Your chosen insurer cannot deny you coverage based on medical history, age, or other factors
- Your chosen insurer cannot charge you higher rates than normal based on your health or other factors
- Your chosen insurer cannot subject you to a waiting period if you have a pre-existing condition or conditions
If you miss this open enrollment period, Plan L can still be enrolled in any time throughout the calendar year. You may be denied coverage or be forced to pay higher rates depending on your medical history without the protection of open enrollment, however.
Once enrolled, you will have a 30-day “free look period” to determine whether to keep your coverage or switch to one of the different Medigap plans.
Medigap Plan L: Is It The Right Plan For You?
Overall, Medigap Plan L is a great supplemental health plan for those who want to save money on their healthcare costs. However, it does have its drawbacks, so it’s important to weigh the pros and cons before making a decision.
Considering Medigap Plan L? It’s a good idea to speak with a licensed insurance professional to make sure this is the right plan for you. Visit Hella Health for even more information on how this plan could help you save on your healthcare costs.