Plan K is one of the Medicare supplement insurance plans also known as Medigap. It has a yearly out-of-pocket limit. Costs include premiums and deductibles.
Medigap plans help fill the gaps in healthcare costs not covered by original Medicare (Part A and Part B). While each of the 10 Medigap plans is standardized, they may vary in premiums and percentage of coverage.
In this article, we describe Medigap Plan K, what the plan covers, how it compares to other Medigap plans, and what it costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medigap Plan K is one of the 10 Medigap policies. The policies are sold by private insurance companies and every policy is standardized, meaning it must follow Medicare rules.
Medigap plans cover costs, also called “coverage gaps”, not covered by Medicare parts A and B. This includes deductibles, copays, and coinsurance.
Because Medigap benefits are standardized by the letter category, every Medigap Plan K must offer the same benefits and costs in every state in which it is offered.
From January 1, 2020, Medigap plans that pay for the Part B deductible are no longer sold to a person who is new to Medicare. The plans are Medigap Plan C and Medigap Plan F. However, if a person enrolled in one of the two plans before January 1, 2020, they may keep the plan.
Medigap plans cover specific benefits, and cannot offer benefits already not covered by original Medicare, such as vision care, hearing care, dental care, private nurses, and long-term care.
Medigap Plan K is one of two plans with an out-of-pocket limit. The other plan is Plan L.
In 2020, the out-of-pocket limit for Plan K is $6,220. After a person has met that limit and the yearly Part B deductible, Medigap pays 100% of the covered services for the rest of the year.
Standard Medigap benefits generally offer some percentage of coverage for the following costs:
- Part A deductible
- Part A coinsurance for hospital costs
- Part A coinsurance or copayment for hospice
- Part A coinsurance for skilled nursing facility care
- Part B deductible
- Part B coinsurance or copayment
- Part B excess charge
- blood, first 3 pints
- foreign travel exchange
- out-of-pocket limit
Some Medigap plans offer benefits Medicare does not cover, such as medical care outside the United States.
Companies can decide which states in which they want to offer the plans, which means not all Medigap plans are offered in all states.
A person can compare different Medigap plans using the Find a Medigap policy website. People enter their zip code and the county where they live. The website then shows all the policies and companies that offer Medigap plans in their area.
While all Medigap letter plans must cover the same benefits, not all policy costs will be the same because companies can charge different amounts for the same policy and the same coverage.
Medigap Plan K provides 100% coverage for Part A coinsurance for hospital costs.
It also gives 50% coverage for Part A deductible, hospice care coinsurance or copays, coinsurance for skilled nursing care, the first 3 pints of blood, and Part B coinsurance or copays.
Plan K does not provide coverage for foreign travel exchange, nor for Plan B deductible or excess charge.
The table below shows the basic benefits and percentage of coverage for Plan K, plus three other plans offering similar benefits. A person can use this online tool to get details about all 10 Medigap plans.
|Benefit||Plan K||Plan D||Plan G||Plan L|
|Part A deductible||50%||100%||100%||75%|
|Part A coinsurance for hospital costs||100%||100%||100%||100%|
|Part A coinsurance or copayment for hospice||50%||100%||100%||75%|
|Part A coinsurance for skilled nursing facility care||50%||100%||100%||75%|
|Part B deductible||no||no||no||no|
|Part B coinsurance or copayment||50%||100%||100%||75%|
|Part B excess charge||no||no||100%||no|
|Blood, first 3 pints||50%||100%||100%||75%|
|Foreign travel exchange||no||80%||80%||no|
This period cannot be changed or repeated, and companies must offer Medigap policies to everyone who asks for them during this time.
If a person does not enroll during the Open Enrollment Period, they may not be able to buy a policy later. In addition, policies may cost more.
This is because companies use medical underwriting to help estimate the risk of offering to insure a person. A company will then decide if a person is allowed to buy a policy and how much the premiums will cost.
While Plan K offers lower monthly premiums than some of the other Medigap plans, it also offers less coverage. For example, Plan K does not cover emergency healthcare costs in a foreign country.
However, Plan K caps yearly healthcare costs, which a person might consider a necessary benefit if they have concerns about unexpected healthcare costs.
A person with Plan K will need to pay the Medicare Part B monthly premium, which usually changes each year. They must also pay the Medicare Part B yearly deductible.
After a person has paid the monthly premiums and yearly deductible, the plan caps healthcare expenses at $6,220 yearly.
Medigap Plan K is a Medigap policy that helps cover the gaps in Medicare parts A and B. It can help pay for Part A deductible, coinsurance, and copays. Medigap plans are sold by private companies.
Medigap Plan K is one of two Medigap policies with a yearly out-of-pocket limit. Once a person meets the limit and pays both the Medicare Part B deductible and the monthly premiums, the plan pays 100% of allowed Medicare charges for the rest of the year.
Features, coverage, and costs vary between Medigap plans, and a person may want to compare the plans before choosing one that is best for them.
Not all Medigap plans are sold in all areas. A person can find plans in their area through an online search.