Plan IV

Plan L

Plan L is a Medicare supplement plan.

Medicare Plan L provides basic coverage for:

Hospitalization: Coverage for Medicare (Part A) daily copays, plus 365 additional days after Medicare benefits end.

Medical expenses: Coverage for Medicare Part B co-insurance (20% of Medicare-approved costs) or copays for doctors’ services, hospital outpatient services, and other medical services*.

Blood: First three pints of blood each year.

Hospice: Co-insurance for inpatient respite care and copays for hospice outpatient prescription drugs.

In addition to the basic benefits, Plan L also provides coverage for your:

Skilled nursing facility copay – 75%

Part A deductible – 75%

Out-of pocket limit $2330; paid at 100% after limit reached

Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%

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