Medigap Plan L

Plan L is the middle ground of the Medigap lineup. It pays 75 percent of most cost sharing instead of all of it. In exchange, the monthly premium sits below Plan G and above Plan K.

Like Plan K, it comes with a safety net. Once your share of covered costs reaches a yearly limit, Plan L pays covered services in full for the rest of the year. Medicare sets that limit, and it changes each year.

• Covered in full: Part A hospital coinsurance, plus 365 extra hospital days after Medicare benefits run out.
• Covered at 75 percent: the Part A hospital deductible for each benefit period.
• Covered at 75 percent: Part B coinsurance for doctor visits, labs, and outpatient care.
• Covered at 75 percent: skilled nursing coinsurance, hospice coinsurance, and the first three pints of blood.
• Not covered: the yearly Part B deductible, Part B excess charges, and foreign travel emergency care.

The honest tradeoff is that you are still self-insuring a slice of every bill. A hospital stay means paying one quarter of the deductible. A year of specialist visits adds up quietly.

• Want the premium as low as it goes? Plan K shares half instead of one quarter.
• Want almost no bills after the deductible? Plan G is the comprehensive choice.
• Want lower cost with predictable copays instead? Plan N is worth pricing too.

Plan K is the closest alternative, since both use the same cost-sharing design. The only real questions are how much of each bill you carry and how fast you reach full coverage.

Judge these two by the worst year you can picture. Plan L's ceiling is roughly half of Plan K's, so a serious health event costs you much less. If the premium gap is small, Plan L is often the better buy.

California treats Medigap members better than most states do. The birthday rule gives you one window each year to change carriers with no health questions.

• The window. It opens on your birthday and stays open for 60 days.
• The limit. You may switch to the same letter with another carrier, or step down to lesser benefits. Moving up from Plan L to Plan G is not allowed under this rule.
• The timing. Start about two months early, since some carriers want the application before the window ends.
• The overlap. Hold your current policy until the new one is issued, so coverage never lapses.

Trial rights come from federal law instead. They protect people who tried Medicare Advantage and want Original Medicare back. Each is a guaranteed-issue right, so no health questions apply.

• You joined Medicare Advantage when you first turned 65. Leave within the first 12 months, and you may buy any Medigap plan sold in California.
• You dropped Medigap to try Medicare Advantage for the first time. Return within 12 months, and you may reclaim your old policy. If it is no longer sold, Plan L is on the list you may buy.

The simplest window is Medigap open enrollment. It runs six months from the month you turn 65 and have Part B. During it, carriers cannot deny you or charge more because of your health.

Outside that window, and without a guaranteed-issue right, most carriers use medical underwriting. That matters for Plan L buyers who may want richer coverage down the road.

• Health questions about conditions treated in the past two to five years.
• A prescription history check, pulled electronically in minutes.
• Height and weight, compared with the carrier's build chart.
• Pending care, such as a scheduled procedure or a test awaiting results.
• A brief phone interview at some carriers, to confirm your answers.

Plan L is a less common letter, so fewer California carriers sell it. Benefits are identical wherever you buy, because federal law standardizes them. That leaves availability, price, and service to compare.

• Which carriers offer Plan L for your age and ZIP code right now.
• How the premium stacks up against Plan K and Plan N for the same person.
• Rate increase history, which matters more in a thin market.
• Household and payment discounts, offered quietly by several carriers.