Medicare Supplement Insurance — Plan L


Get a no-obligation quote for Medicare Supplement coverage from Blue Cross and Blue Shield of Texas


If you are willing to share certain health care costs, this Medicare Supplement insurance plan can help you save on premiums while still receiving dependable coverage.

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Medicare Supplement insurance costs include monthly premium payments and may include deductibles, out-of-pocket expenses, copayments and coinsurance. Here are some of the costs you can expect to pay with Plan L:

  • Your Part B deductible
  • Part B excess charges
  • 25 percent of your Part A deductible
  • All hospitalization costs beyond the additional 365 days after the Lifetime Reserve are used
  • A portion of cost after 21 days in a skilled nursing facility, and all costs after 101 days
  • 25 percent of the cost of the first three pints of blood

For more information on costs, get a quick quote or see the Medicare Supplement Outline of Coverage.


  • Basic benefits:
    • 75% of Part A deductible for hospitalization services
    • 75% of the costs for the first three pints of blood each year
    • 75% of Medicare coinsurance for hospice care
  • Skilled nursing facility coinsurance (75%)
  • Part A deductible (75%)

More Plan Details

It's important to know the critical features of the Medicare Supplement insurance plan you are considering. The Outline of Medicare Supplement Coverage provides brief descriptions of the basic provisions of the Medicare Supplement insurance plans, as well as details on policy renewability, benefit exclusions and coverage limitations.




Blue Cross and Blue Shield of Texas (BCBSTX) will never terminate or refuse to renew your Medicare Supplement Insurance policy because of the condition of your health. However, to protect you and the rights of all policy holders, there are situations when a Medicare Supplement insurance plan may be terminated or a renewal refused:

  • Failure to pay
  • Discovery of fraud or an intentional misrepresentation of facts (30 days prior written notice given)


Services Medicare Pays Plan Pays You Pay
HOSPITALIZATION*: Semi-private room and board, general nursing, and miscellaneous services and supplies
First 60 days All but $1,260 75% of Part A deductible 25% of Part A deductible
61st through 90th day All but $315 a day $315 a day $0

91st day and after:
– While using 60 Lifetime Reserve Days
– Once Lifetime Reserve Days are used:
   Additional 365 days


All but $630 a day

$0


$630 a day

100% of Medicare eligible expenses

$0

$0**
Beyond the additional 365 days $0 $0 All costs
SKILLED NURSING FACILITY CARE*: You must meet Medicare's requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital
First 20 days All approved amounts $0 $0
21st through 100th day All but $157.50 a day Up to $114 a day Up to $38 a day
101st day and after $0 $0 All costs
BLOOD
First three pints $0 75% 25%
Additional amounts 100% $0 $0
HOSPICE CARE: You must meet Medicare's requirements, including a doctor's certification of terminal illness
  All but very limited copayment/coinsurance
for outpatient drugs and inpatient respite care
75% of Medicare copayment/
coinsurance
25% of Medicare copayment/
coinsurance

* A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.


Services Medicare Pays Plan Pays You Pay
MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physicians' services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment
First $147 of Medicare-approved amounts* $0 $0 $147
(Part B deductible)
Preventive benefits for Medicare-covered services Generally 75% or more of Medicare-approved amounts Remainder of Medicare-approved amounts All costs above Medicare-approved amounts
Remainder of Medicare-approved amounts Generally 80% Generally 15% Generally 5%
PART B EXCESS CHARGES (above Medicare-approved amounts)
  $0 $0
All costs (and they do not count toward annual out-of pocket limit of $2,470 )**
BLOOD
First three pints $0 75%
25%
Next $147 of Medicare-approved amounts* $0 $0 $147
(Part B deductible)
Remainder of Medicare-approved amounts Generally 80% Generally 15% Generally 5%
CLINICAL LABORATORY SERVICES— TESTS FOR DIAGONOSTIC SERVICES
  100% $0 $0

* Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

** This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $2,470 per year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts ("excess charges") and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or services.


Services Medicare Pays Plan Pays You Pay
HOME HEALTH CARE MEDICARE-APPROVED SERVICES
– Medically necessary skilled care services and medical supplies 100% $0 $0
– Durable medical equipment
First $147 of Medicare-approved amounts*
$0 $0 $147
(Part B deductible)
Remainder of Medicare-approved amounts 80% 15% 5%

* Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.



BCBSTX is not connected with or endorsed by the United States Government, the Federal Medicare Program or any other governmental agency.

TXMEDWEBL-REV 08/12