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.
- 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
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.
- 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
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.
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.
- 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
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.
7 Cited Research Articles
- U.S. Centers for Medicare & Medicare Services. (2020, November). Getting Started With Medicare. Download. Retrieved from https://cmsnationaltrainingprogram.cms.gov/system/files_force/2020_Medigap_508_FINAL.pptx?download=1
- U.S. Centers for Medicare & Medicare Services. (2020, October 6). K & L Out-of-Pocket Limits Announcements. Retrieved from https://www.cms.gov/Medicare/Health-Plans/Medigap/KandL
- Bunis, D. (2020, July 6). Medigap Plans Help Bridge Gap of Original Medicare Costs. Retrieved from https://www.aarp.org/health/medicare-insurance/info-2017/choosing-right-medigap-plan.html
- U.S. Centers for Medicare & Medicare Services. (2020, February). Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare. Retrieved from https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf
- U.S. Centers for Medicare & Medicare Services. (n.d.). How to Compare Medigap Policies. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
- U.S. Centers for Medicare & Medicare Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
- U.S. Centers for Medicare & Medicare Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance