Plan L of the Medicare Advantage plan is a cost-sharing plan, which means that the benefits are not fully covered. It covers 75% of most of the out-of-pocket expenses and the remaining 25% has to be paid by the policyholder themselves. The cost-sharing under the Plan L is considerably higher than most other plans, meaning the customers of the Plan L will have to bear greater out-of-pocket expenses. Since the cost-sharing is higher, the Plan L has a lower monthly premium than other Medicare Advantage plans. The details of the features and benefits of the Plan L and its suitability for customers are provided below:
Features of Plan L
The Plan L covers the entire cost pertaining to the Medicare Part A coinsurance. It covers the Medicare Part B coinsurance and copayments. The Medicare Part B pays for 80% of the Medicare-approved amount for the covered services. The Plan L being a cost-sharing plan covers 75% of the remaining 20% Part B copayment. The customers are also covered for up to the first three pints of blood for medical procedures. It provides coverage of 75% related to the Part A hospice care coinsurance and copayment and 75% of the coinsurance for medical care provided by the skilled nursing facility (NCF). The Plan L of the Medicare Advantage plan covers 75% of the Medicare Part A deductible. It, however, does not cover the deductible for Medicare Part B.
The Medicare Advantage Plan L has a yearly out-of-pocket limit. This means that as the customers hit this out-of-pocket limit, they are provided 100% coverage of the benefits and they not need to pay any additional benefits. The out-of-pocket limit for the year 2018 is $2,620, provided the medical expenses are for Medicare-covered services. This out-of-pocket limit is inclusive of the deductible for Original Medicare Part B ($183 for the year 2018). Once the customers reach their out-of-pocket limit, then the Plan L pays 100% of the Original Medicare costs that it is required to cover for the remainder of the year.
Is it Suitable for Customers?
Plan L is not a popular Medicare Advantage plan in the United States. As per the data of 2014, only 16% of the total insurance carriers sold the Plan L and a mere 0.5% of the total Medigap policies sold in 2014 consisted of Plan L. It is a basic health coverage plan with modest monthly premiums. It can be suitable for customers wanting an affordable plan with basic health coverage and who are fine with the annual out-of-