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
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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