Medigap Plan K is one of 10 standardized Medicare Supplement insurance options available in most states. Learn about how Plan K may fit your health care needs.
What Is Medigap?
Medigap, or Medicare Supplement Insurance, is a type of private Medicare insurance that supplements your Original Medicare (Part A and Part B) benefits.
A Medigap plan covers some of the out-of-pocket expenses associated with Original Medicare. These costs include deductibles, copayments, coinsurance and more.
What Is Medicare Supplement Plan K?
Plan K is a cost-sharing plan. That means some of the benefits aren’t fully covered.
For example, instead of covering the entire Medicare Part A deductible, it only pays 50%. You would have to pay the remaining 50%.
What Is the Plan K Out-of-Pocket Limit?
While Plan K provides less coverage for most benefit areas than some other types of Medigap plans, Plan K does come with one potentially attractive feature: An out-of-pocket spending limit.
The out-of-pocket limit is an annual cap on your out-of-pocket spending for covered services.
For 2019, the out-of-pocket maximum for Plan K is $5,560 for the year. That means once you have contributed $5,560 out of your own pocket toward benefit areas covered by Plan K, the plan pays 100% of all of your covered services and items for the remainder of the year.
Plan K is one of only two Medigap plans to include an out-of-pocket limit. This is a strong selling point for this plan because Original Medicare features no out-of-pocket limit.
How Popular Is Medigap Plan K?
Plan K is not a common plan option for either Medigap companies or beneficiaries.
Only 15% of Medigap insurers offered Plan K in 2017, and only about 1% of Medigap policyholders enrolled in Plan K that year.¹
What Does Plan K Cover?
Plan K offers full coverage for 1 benefit and 50% cost-sharing coverage for 5 others.
|
Standard Medicare Supplement Insurance benefits |
Plan K |
|---|---|
|
Medicare Part A coinsurance and hospital costs |
✓ |
|
Medicare Part B coinsurance or copayment |
50% |
|
First 3 pints of blood |
50% |
|
Part A hospice care coinsurance or copayment |
50% |
|
Coinsurance for skilled nursing facility |
50% |
|
Medicare Part A deductible |
50% |
|
Medicare Part B deductible |
|
|
Medicare Part B excess charges |
|
|
Foreign travel emergency |
Medicare Part A Coinsurance
Medicare Part A is known as hospital insurance and it includes cost-sharing measures like coinsurance. Inpatient hospital stays covered by Medicare Part A require coinsurance fees if they exceed 60 days. This is the only basic benefit Medigap Plan K covers at 100%.
Medicare Part B Coinsurance and Copayment
Medicare Part B usually charges a coinsurance and copayments for doctor visits and other outpatient care. Medicare Part B typically pays for 80% of the Medicare-approved amount for covered services, leaving a 20% coinsurance in most cases.
Plan K pays for half of these costs, meaning that an insured person would have to pay for the remaining coinsurance or copayment costs.
First 3 Pints of Blood
Original Medicare only covers the fourth pint of blood and beyond. If you need blood while in the hospital, Plan K will cover half of the cost of the first 3 pints.
Part A Hospice Care Coinsurance or Copayment
Hospice care provides medical treatment and care during a terminal illness. Medicare covers these services, but it requires copayments.
These copayments include $5 for each symptom and pain relief prescription drugs and 5% of the Medicare-approved amount for inpatient respite care. Plan K covers half of these costs.
Coinsurance for Skilled Nursing Facility Care
Half of the coinsurance for medical care provided at skilled nursing care facilities is covered by Plan K.
Medicare Part A Deductible
Medicare Part A comes with a deductible, which is $1,364 per benefit period in 2019. Medigap Plan K will pay for half that deductible for each benefit period.
With Plan K, you still have to pay the Medicare Part B deductible, which is $185 in 2019.
For more detailed information, read our page about Medicare Supplement Insurance benefits.
Plan K vs. Other Medigap Plans
Plan K is similar to Plan L, but it provides less coverage.
This plan does have cost-sharing, but the out-of-pocket limit protects you from paying over a certain amount each year.
To see the difference between Plan K and the other standardized Medigap plan options, please review the chart below.
What Does Plan K Not Cover?
There are three benefit ares in which Plan K does not offer any coverage.
- Medicare Part B deductible.
The Medicare Part B deductible is $185 per year in 2019. That means you must contribute $185 toward services and items covered by Part B before before your Part B coverage kicks in.If the Part B deductible is covered by a Medigap plan, your Part B coverage will begin immediately.
- Medicare Part B excess charges
A health care provider who accepts Medicare assignment accepts Medicare’s reimbursement for their services as payment as full.Providers who do not accept Medicare assignment reserve the right to charge up to 15% more than the Medicare-approved amount for their service or item. This is called an “excess charge.”
Excess charges only apply to Part B of Medicare and can be avoided by visiting only providers who accept Medicare assignment.
- Foreign travel emergency care
Original Medicare provides coverage for emergency care received outside of the U.S. only under very limited circumstances.Certain Medigap plans provide coverage for 80% of the cost of qualified foreign emergency care. Plan K does not offer any coverage in this benefit area.
Plan K Enrollment Statistics
Although only 1% of all Medigap policyholders belonged to Plan K in 2017, this plan saw tremendous growth from the previous year.1
The total number of Plan K enrollees increased from 75,813 in 2016 to 82,066 in 2017, which represents an 8% increase in just one year’s time. Only two other Medigap plans saw faster growth over that period.
The states with the highest Plan K enrollment in 2017 were Florida (8,492 total enrollees), New York (7,734), California (6,392), Washington (6,343) and Texas (5,922).
Plan K is accepted in all 50 U.S. states as well as Washington D.C., Puerto Rico, the Virgin Islands and Guam.
Why Choose Plan K?
How can you be sure Plan K is right for you?
Because Plan K is a cost-sharing plan that does not provide full coverage for certain Medigap benefit areas, the monthly premiums for this plan are typically kept lower than other plans.
The annual out-of-pocket limit can also protect you from potentially expensive medical bills that can add up quickly.
And lastly, the three benefit areas not covered by Plan K may not be relevant to many beneficiaries. Depending on your unique situation, Plan K may offer the coverage that fits your needs better than some other plans.
A licensed insurance agent can help you compare Medigap plans available in your area so that you can find the right plan for you.
Compare Medigap plans in your area.
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1 State of Medigap 2019. AHIP. Retrieved from https://www.ahip.org/wp-content/uploads/IB_StateofMedigap2019.pdf.
2 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.