Medigap Plan K is one of 10 standardized Medicare Supplement insurance options available in most states. (Massachusetts, Minnesota, and Wisconsin have different options.) Learn about how this plan may fit your health care needs.
Medigap Plan K: An Overview
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%.
However, there is an annual limit on cost-sharing. Once you hit that limit, Plan K starts paying for 100% of covered benefits, and you don’t have to pay anything more. This is called an “out-of-pocket limit.” The out-of-pocket limit for Plan K is $5,560 in 2019.
Plan K is not a common plan option for either Medigap companies or beneficiaries. According to 2014 statistics from America’s Health Insurance Plans, only 16% of Medigap insurers offer this plan, and only about 1% of Medigap policyholders bought this plan in 2014.
Keep reading for details on Plan K’s benefits and enrollment rates, in addition to how the benefits compare to other plan options.
Plan K Benefits
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 co-insurance and hospital costs |
√ |
|
Medicare Part B co-insurance or co-payment |
50% |
|
First 3 pints of blood |
50% |
|
Part A hospice care co-insurance or co-payment |
50% |
|
Co-insurance 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 co-insurance: Medicare Part A is known as hospital insurance and it includes cost-sharing measures like co-insurance. Inpatient hospital stays covered by Medicare Part A require co-insurance fees if they exceed 60 days. This is the only basic benefit Medigap Plan K covers at 100%.
Medicare Part B co-insurance and co-payment: Medicare Part B usually charges a co-insurance and co-payments 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% co-insurance in most cases. Plan K pays for half of these costs, meaning that an insured person would have to pay for the remaining co-insurance or co-payment 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 co-insurance or co-payment: Hospice care provides medical treatment and care during a terminal illness. Medicare covers these services, but it requires co-payments. These co-payments 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.
Co-insurance for skilled nursing facility: Half of the co-insurance 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 option comparison
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.
Plan K vs. other Medigap plan options
| Medicare Supplement Benefits | A | B | C | D | F1 | G | K2 | L3 | M | N4 |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A co-insurance and hospital costs | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Part B co-insurance or co-payment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| First 3 pints of blood | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A hospice care co-insurance or co-payment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Co-insurance for skilled nursing facility | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ | ||
| Medicare Part A deductible | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | 50% | ✓ | |
| MedicarePart B deductible | ✓ | ✓ | ||||||||
| Medicare Part B excess charges | ✓ | ✓ | ||||||||
| Foreign travel emergency | 80% | 80% | 80% | 80% | 80% | 80% | ||||
| 1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything. 2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission. | ||||||||||
Plan K Enrollment Statistics
America’s Health Insurance Plans (AHIP) found that only 16% of Medigap insurers offer this plan.1 Only about 1% of Medigap policyholders chose this plan in 2014.
In one year’s time, this plan experienced a significant amount of growth. In 2013, Plan K had 49,674 enrollees, which jumped 17% to 58,166 in 2014, according to AHIP.
1 https://www.ahip.org/wp-content/uploads/2016/04/MedigapEnrollmentReport_Linked.pdf