Medicare Supplement Plan L Details
Part A |
|||
| Services | Medicare Pays | This Plan Pays | You Pay |
|---|---|---|---|
| -Plan Notes- | |||
| Annual out-of-pocket limit | $0 | $0 | Up to $3530 |
| Hospitalization | |||
| First 60 Days | All But $1632 | $1224 (75% of Deductible) | $408 (25% of Deductible) |
| 61st Through 90th Day | All But $408 a Day | $408 a Day | $0 |
| 91st Day and After (60 Reserve Days) | All But $816 a Day | $816 a Day | $0 |
| After Reserve (Additional 365 Days) | $0 | 100% of Eligible Expenses | $0 |
| Beyond the Additional 365 Days | $0 | $0 | All Costs |
| Skilled Nursing Facility Care | |||
| First 20 Days | All Approved Amounts | $0 | $0 |
| 21st Through 100th Day | All But $204 a Day | Up to $153 a Day (75%) | Up to $51 a Day (25%) |
| 101st Day and After | $0 | $0 | All Costs |
| Blood | |||
| First Three Pints | $0 | 75% | 25% |
| Additional Amounts | 100% | $0 | $0 |
| Hospice Care | |||
| Must Meet Medicare's Requirements | All but very limited coinsurance, coinsurance for outpatient drugs and inpatient respite care. | 75% of Copayments and Coinsurance | 25% of Copayments and Coinsurance |
Part B |
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| Services | Medicare Pays | This Plan Pays | You Pay |
|---|---|---|---|
| Medical Expenses | |||
| 1st $240 of Approved Amounts | $0 | $0 | $240 (Part B Deductible) |
| Preventative Benefits | Generally 75% | Remainder of Approved Costs | All Costs Above Approved Costs |
| Remainder of Approved Amounts | Generally 80% | Generally 15% | Generally 5% |
| Part B Excess Charge | $0 | $0 | All Costs (NA to Max Out of Pocket |
| Blood | |||
| First Three Pints | $0 | 75% | 25% |
| Next $240 of Approved Amounts | $0 | $0 | $240 (Part B Deductible) |
| Remainder of Approved Amounts | Generally 80% | Generally 15% | Generally 5% |
| Clinical Laboratory Services | |||
| Tests for Diagnostic Services | 100% | $0 | $0 |
Parts A & B |
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| Services | Medicare Pays | This Plan Pays | You Pay |
|---|---|---|---|
| Home Health Care | |||
| Medically necessary skilled care services and medical supplies | 100% | $0 | $0 |
| Durable Medical Equipment | |||
| 1st $240 of Medicare approved amounts | $0 | $0 | $240 (Part B deductible) |
| Remainder of medicare approved amounts | 80% | 15% | 5% |