Medigap Plan K Supplement Insurance

Medigap Plan K is a Medicare Supplement plan that pays half of many Original Medicare out-of-pocket expenses until you hit your plan’s maximum out-of-pocket limit for the year. After reaching that limit, Medigap Plan K pays 100 percent of the Medicare-covered costs that Plan K covers.

What Does Medigap Plan K Cover?

Medigap Plan K is a Medicare Supplement insurance plan that helps you pay for out-of-pocket costs associated with Original Medicare — Medicare Part A and Part B.

While most Medigap plans cover 100 percent of most costs, you will still have to pay some out-of-pocket costs under Plan K until you meet your Part B deductible and your plan’s maximum out-of-pocket (MOOP) limit for the year – $6,220 in 2021.

Medigap Plan K Coverage
  • 100 percent of Medicare Part A coinsurance and hospital costs for an extra 365 days after your Original Medicare benefits are used up
  • 50 percent of the following Medicare costs until you reach your MOOP each year:
    • Medicare Part A deductible
    • Medicare Part A hospice care coinsurance or copayment
    • Medicare Part B coinsurance or copayment
    • First three pints of blood for medical procedures each year
    • Skilled nursing facility care
  • 100 percent of the above listed out-of-pocket costs for the remainder of the calendar year after you reach your MOOP
Source: U.S. Centers for Medicare & Medicaid Services

As an example of how Plan K would work, here’s how it would cover your Medicare Part B medical insurance coinsurance payment. If you had a $100 medical bill from an office visit with your doctor, Part B would pay $80. You would have to pay the remaining $20.

With Medigap Plan K, the plan would pay $10 and you would pay the other $10.

There are some out-of-pocket costs that Medigap Plan K does not cover.

Out-of-Pocket Costs Not Covered by Medigap Plan K
  • Medicare Part B deductible – $203 in 2021
  • Medicare Part B excess charges – charges over and above the Medicare-approved amount that your doctor is legally allowed to bill you for medical services
  • Emergency medical care while traveling in a foreign country
Source: U.S. Centers for Medicare & Medicaid Services

Medigap Plan K does not cover prescription drugs or dental, vision and hearing care. No Medigap plans cover these costs.

If you want help paying for prescriptions, you can purchase a Medicare Part D prescription drug plan from a private insurer. You can also purchase a Medicare Advantage plan — most contain Medicare Part D benefits. Medicare Advantage plans may also cover dental, vision and hearing care.

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How Much Does Medigap Plan K Cost?

Medicare Plan K policies are sold by private insurers. Monthly premium costs vary from company to company and depending on where you live. Plan K premiums are in addition to monthly premiums you have to pay for Original Medicare and optional Medicare Plan D prescription drug coverage.

Medigap Plan K Costs to Consider
  • Monthly premiums – amount varies depending on location and plan administrator
  • Medicare Part B hospital insurance deductible – up to $203 in 2021
  • Medigap Part B excess charges – if you have any
  • 100 percent of any medical care while traveling outside the United States
  • Maximum out-of-pocket costs before Plan K provides full coverage – up to $6,220 in 2021
Source: U.S. Centers for Medicare & Medicaid Services

Your monthly premiums for Medigap Plan K and other Medicare coverage — Medicare Part A, Part B and Part D — do not apply to your maximum out-of-pocket limit.

What Is the Difference Between Medigap Plan K and Plan L?

Medigap Plan K is similar to Plan L. When comparing Medigap plans, note that the key difference is that Plan L provides more benefits and a lower maximum out-of-pocket limit. Where Plan K covers 50 percent of some out-of-pocket costs, Medigap Plan L covers 75 percent until you meet the Plan L MOOP – $3,110 in 2021.

Either Medigap Plan K or Plan L may be a good fit if you prefer coverage similar to an employer health insurance plan and are not bothered by out-of-pocket costs.

They may also be right for you if you live in a state that doesn’t allow Medicare Part B excess charges, are in relatively good health, don’t have serious health problems and seldom have to visit a doctor.

Last Modified: July 12, 2021

7 Cited Research Articles

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