Medicare Plan L gives reduced premiums if you’ll share costs
Medigap Plan L is a good cost-sharing medicare supplement policy. In exchange for generally a lower premium than what you might pay for a Medicare Plan F, when you purchase a Medigap Plan L, the insurance carrier will pay 75% of your Medicare approved healthcare expenses, and you’ll pay the other 25% out of your own pocket. When you buy a Medicare Plan L you also must pay the Medicare Part B deductible and any Medicare Part B excess charges on your own.
Medicare Supplement Plan L – Provides Out–of–Pocket Maximum Cap Protection
A Medicare Plan L supplemental policy also includes a cap on your healthcare expenses. The insurance companies refer to this as your out of pocket limit or maximum. The Centers for Medicare and Medicaid set this limit annually, and in 2018, the maximum out of pocket limit for Plan L is $2,620. This means that if at any point in the calendar year your out of pocket spending reaches $2,620 in Medicare-approved expenses, then your supplemental insurance carrier pays 100% of your medical expenses for the rest of the year. Having a ceiling or a cap makes it much easier because you can control your costs on an annual basis, knowing that although at times you’re required to pay 25% coinsurance for certain medical services, there is an overall limit to the amount that you’ll have to pay for the entire year. This can bring some peace of mind knowing that even if you experience a serious medical condition that requires expensive treatments, your costs cannot exceed a set amount each year.
Let’s say that Mrs. Roberts buys a Medicare supplement plan L policy. She later needs to have an outpatient surgery procedure to remove her gall bladder. If Medicare’s approved amount for this surgery is $2,000, then his Plan L supplement will pay $1500, and Mrs. Roberts will be responsible for the other $500.
The amounts she pays in deductibles, coinsurance and copayments is also tracked by her private insurer and measured against her out of pocket maximum, so that if her out-of-pocket costs in that calendar year reach $2,620, then her Medigap Plan L will pay 100% of all Medicare approved healthcare expenses for the rest of the year.
Mrs. Roberts’s insurance policy also functions in the same way for her share of any outpatient medical expenses under Part B, except that she’ll be responsible for paying the annual Medicare Part B deductible.
Let’s assume Mrs. Roberts has already paid her Medicare Part B deductible of $183 earlier this year when she had an ordinary doctor vist. However later that year, her doctor wants her to have an MRI. Since this is a Medicare approved procedure, Original Medicare will pay 80% of the cost for the MRI, and her supplemental Plan L will pay 75% of the remaining balance. If the MRI cost is $3000, then Medicare pays $2,400, her Medicare Plan L pays $450 (75% of the remaining $600), and Mrs. Roberts is responsible for the $150 difference. So in other words, on a $3,000 procedure she’ll only pay $150 out of her own pocket.
In most states, each private insurer decides which Medicare supplements plans it will offer to medicare beneficiaries looking to buy coverage. While it is easy to find carriers for the most-popular Medicare Plan F, not so many carriers offer the Medigap Plan L as a supplement to Original Medicare. By working with our medicare licensed specialist, we can find the right coverage for you at the lowest rate available in your area. Working with a trusted insurance professional that specializes in Medicare insurance products does not cost you a dime and can save you alot of time and effort you would otherwise put into researching the different companies and prices.
Contact our medicare coverage helpline and speak with a licensed agent, we work with the major insurance carrier’s in most states. Call us now at 866-936-3831 or fill out our online form to get a quote today!