Medicare supplement Plan K is a Medigap policy. These policies help cover the “gaps” in original Medicare Part A and Part B.
Private insurance companies sell Medigap policies, although not all policies are available in every state.
In this article, we describe Medicare Plan K, plan availability, benefits and restrictions, enrollment, and 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.
Medicare supplement Plan K is one of 10 Medigap policies. A person must have original Medicare to buy a Medigap policy, and each policy covers a different set of standard benefits.
Medigap Plan K covers only one person. If a spouse wants Medigap Plan K, they must buy their own policy.
Medigap policies are sold by private insurance companies, but not all 10 Medigap policies are available in every state.
An insurance company decides which policies they offer, although federal laws govern that:
- companies do not have to offer all 10 Medigap plans
- a company must offer Medigap Plan A if they sell any Medigap plans
- a company must also offer Plan C or F if they sell any Medigap plans
Medicare standardizes the benefits offered in each Medigap policy, which means every Medicare Plan K will have the same standard benefits.
Some insurance companies may choose to offer more benefits, although the policy cost may increase as result.
In general, most Medigap policies do not cover:
- eye examinations for glasses
- teeth examinations or cleanings
- hearing tests
- hearing aids
- private duty nurses
The chart below shows what benefits are, or are not, covered by Medigap Plan K.
|Benefit||Does Plan K cover?|
|Part A deductible||50%|
|Part A coinsurance and hospital costs||yes|
|Part A coinsurance or copayment for hospice||50%|
|Part A coinsurance for skilled nursing facility care||50%|
|Part B deductible||no|
|Part B coinsurance or copayment||50%|
|Part B excess charge||no|
|blood, first 3 pints||50%|
|foreign travel exchange||no|
The following information provides more detail about Part B deductible, out-of-pocket costs, and excess charges.
Part B deductible: Medigap plans C and F cover the Part B deductible. After January 1, 2020, they cannot be sold to people new to Medicare, but people who already had the policy can keep it.
Out-of-pocket costs: After a person meets the yearly limit and Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.
Excess charge: This is the difference between what Medicare approves and what the doctor might charge.
Medigap Plan K restricts coverage for some benefits until a person meets the yearly out-of-pocket limit. Restricted coverage affects the following benefits:
- Part A deductible to 50%
- Part A coinsurance or copayment for hospice to 50%
- Part A coinsurance for skilled nursing facility care to 50%
- Part B coinsurance or copayment to 50%
- first 3 pints of blood to 50%
In addition, Medigap Plan K policies do not cover either Part B excess charges or foreign travel.
A person can buy Medicare Supplement Plan K during the 6 month Medigap Open Enrollment Period, which starts the month a person turns 65. They have to be enrolled in Medicare Part B to enroll in a Medigap plan.
During this open enrollment, a person may buy Medigap Plan K even if they have health problems. They will be charged at the same price as people with good health.
After open enrollment, a person may not be able to buy a Medigap policy. This is because Medicare allows a company to use medical underwriting after the Open Enrollment Period. The process rates a person’s risk based on health conditions, age, lifestyle choices, and other factors.
This process helps a company decide if they will cover a person and how much to charge. Therefore, if a company does decide to sell coverage, the premiums may be higher.
Guaranteed issue rights, also known as Medigap protection, means a person cannot be refused a policy if their other health coverage changes.
For example, if a person’s Advantage plan leaves Medicare or stops coverage in a person’s area, then a person may buy a Medigap policy with the same benefits as during the Open Enrollment Period.
Medigap Plan K monthly premiums are paid to the private company offering the plan. However, a person pays the premium for original Medicare directly to Medicare.
Companies can decide on the premium amounts, although they are limited by three methods. The way the price is set affects how much people pay for as long as they have the policy. The limits are:
- Attained-age-rated: The premium goes up as people get older.
- Community-rated: All people pay the same premium no matter how old they are. However, premiums can change based on inflation or other factors.
- Issue-age-rated: The price is based on a person’s age when they buy the policy. The premium can not be raised on the basis of age.
Other out-of-pocket expenses with Medigap policies may depend on factors determined by the company. For example, some companies offer discounts for people who have healthy habits or use electronic payment.
In addition, Medicare SELECT policies offer reduced premiums, but people must use in-network providers.
Medicare Plan K is a Medigap policy. It helps cover the “gaps” in original Medicare coverage. This can include Part A deductible, coinsurance, copayments, and blood.
People must pay a yearly out-of-pocket limit of $5,880 with Medigap Plan K. Once a person meets the limit the policy pays 100% of approved cost for the rest of the year.
Medicare Supplement Plan K does not cover foreign travel or Part B excess charge. Most Medigap policies do not cover eye, dental, teeth, or long-term care.
Private insurance companies sell Medigap Plan K policies. They may cover more than standard benefits. The policies may cover the same benefits but can charge different premiums.