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Medicare Supplement Insurance: Plan K

If you’re enrolled in Original Medicare, Part A and Part B, Medicare Supplement (Medigap) insurance may help pay for some of the out-of-pocket costs that Original Medicare doesn’t cover. There are up to 10 standardized plan types available in most states, and each plan type offers a different set of basic benefits.


Medigap Plan K is one type of Medigap plan that may be available in your state. Plan K offers benefits to help pay for a variety of Medicare out-of-pocket costs and services.


Unlike most of the Medigap plan types, Medigap Plan K includes an out-of-pocket yearly spending limit $5,560 in 2019 for Medicare-covered services. Once your out-of-pocket spending has reached the plan limit, Medigap Plan K pays 100% of covered services for the remainder of the calendar year.


Unlike Medicare Advantage plans, Original Medicare does not come with a maximum spending limit, meaning there is no annual cap on your health-care expenses, no matter how high your medical costs may get. Plan K’s out-of-pocket limit may be helpful if you want protection in the event of a medical emergency, where your medical bills could potentially reach thousands of dollars. With Plan K, you’ll have peace of mind knowing there’s a cap on your Medicare costs for a given year.


Beneficiaries who frequently require medical services and may have high out-of-pocket costs may also want to consider Plan K if they believe their medical costs could go above the plan’s yearly limit.


Medicare Supplement insurance: Plan K basic benefits

Medigap Plan K’s benefits pay 50% of several cost-sharing expenses in Original Medicare, which may include the following costs and benefits:

  • Part A deductible
  • Part A hospice care coinsurance or copayment
  • Part B copayment or coinsurance
  • First three pints of blood for a covered medical procedure
  • Skilled nursing facility (SNF) care coinsurance

With Medigap Plan K, beneficiaries must pay both the Medicare Part B deductible and Part B excess charges in full; Plan K doesn’t cover these costs.


Medicare Part B excess charges are extra charges your doctor may bill you for outside of the Medicare-approved charge. Medicare has a “fee schedule” of approved amounts that doctors may charge for Medicare-covered services; however, doctors who do not accept assignment may charge up to 15% above these amounts.


For example, Medicare’s approved charge for a doctor appointment could be $100, but the physician may choose not to accept that amount and instead charge an additional 15% for the appointment, so the total cost is $115. In this example, Medicare will pay 80% of the allowed charge, sending the physician $80. The beneficiary is responsible for paying not only the remaining $20, but also the excess 15% charge, another $15, making the total out-of-pocket cost $35.


Plan K basic benefits include the Medicare Part A coinsurance hospital costs, covering up to an extra 365 days after Medicare benefits are exhausted. This is the only benefit that Plan K may pay in full.


Comparing Medigap Plan K with other Medicare Supplement insurance plans

Medigap Plan K requires beneficiaries to pay a lot of costs up front, so you may want to consider if higher out-of-pocket expenses are a concern for you before purchasing this policy.


Remember, because Medigap benefits are standardized in most states, you’ll get the exact same basic benefits for plans of the same letter, no matter where you live or which insurance company you purchase from. This means that the main difference between Medigap plans of the same type is the premium cost.


If you’d like to compare other Medigap plan options side-by-side, our Medigap plan finder makes it simply to compare the benefits of Medigap Plan K against other Medicare Supplement insurance plans. If you have questions or would like to discuss your Medicare needs, contact eHealth to speak with a licensed insurance agent.


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