Medicare Plan K
Key Takeaways
- Medicare Plan K is a Medicare Supplement (Medigap) Medicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you’ll need to pay. plan.
- Plans like Plan K are private insurance plans that can be used as supplemental insurance alongside Original Medicare Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
- Medigap Plan K can help offset certain medical expenses you might have after Medicare covers its share.
- You cannot purchase Plan K or other Medigap plans if you have a Medicare Advantage Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan.
What is Medicare Supplement Plan K ?
Medicare Plan K is one of the 10 Medicare supplemental insurance plans that you can buy to help cover your medical costs after Medicare pays its share. You can only buy these plans with Original Medicare, not Medicare Advantage plans.
Each Medigap plan has to follow rules set by Medicare and meet certain federal and state standards. Private insurance companies offer these plans, but each has to offer the same basic services, and every insurance company doesn’t have to offer every type of supplemental plan.
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Medicare Supplement Plan K Coverage
After Medicare pays its share of your Part A and Part B — also known as Original Medicare — claims, you still have some costs left to cover on your own. This is where Medigap plans come in.
There are 10 different Medigap plans, and each offers slightly different coverage. Plans K and L are the only two plans that limit your annual out-of-pocket costs.
While Medicare Plan K coverage may vary slightly by insurance company, coverage must include the following:
- 100% coverage of Part A coinsurance for up to 365 days after Medicare benefits are exhausted.
- 100% coverage of Part A hospital costs for up to 365 days after Medicare benefits are exhausted.
- 50% coverage of your Part A deductible.
- 50% coverage of your Part A hospice care coinsurance and copayment.
- 50% coverage of the first three pints of blood you may need.
- 50% coverage of coinsurance charges for a skilled nursing facility.
- 50% coverage of your Part B coinsurance or copayments.
What’s Not Covered by Medicare Plan K?
There are certain costs that the Centers for Medicare & Medicaid Services dictate insurance companies must pay for each Medigap plan — and there are some costs that these plans can’t cover.
Medicare will not allow Medigap Plan K to cover:
- Part B deductible fees
- Excess charges under Medicare Part B
- Foreign travel exchange fees
Medicare Plan K Costs
The monthly premium A premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost.
for Medigap plans can vary widely from one insurance company to the next.
Medicare offers an online tool to help you compare what is offered and for what price in your area. Discounts may be available based on things like gender, military background, smoking status and more.
Medigap plans are categorized or “rated” three different ways, based on whether you want to pay more upfront or later.
- Community-rated or “no age-rated” plans charge the same price to everyone regardless of age. Prices can rise, but only due to market conditions, not your age.
- Issue age-related or “entry age-rated” plans are priced based on the age you are when you first purchase your Medigap plan. You get the best deal with these plans by buying them when you are younger. Premiums won’t increase as you age, but may rise with inflation or other market conditions.
- Attained age-rated plans are based on your current age. This means that your premium may be lower when you are younger, but the price can rise over time as you age.
Plan K Out-of-Pocket Limit
With all Medigap plans, your insurance company will outline what is covered, how much you have to pay as a deductible before your coverage begins, and any limits that are set on your coverage.
Plan K and Plan L are the only two Medigap plans that have a cap on your annual out-of-pocket costs. This means that once you have paid your Medicare Part B deductible and spent a certain amount on your covered out-of-pocket expenses for the year, your Medigap plan will cover the rest.
The annual limit can change from year to year based on inflation, and was set at $7,060 for Plan K and $3,530 for Plan L in 2024.
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Medicare Plan K vs Plan L
Plan K and Plan L are similar in terms of what they cover and the fact that they both offer annual out-of-pocket limits. The difference between the two is how much is covered for the cost of the plan.
Plan costs can vary by insurance company, but overall, Plan L has higher coverage amounts and a lower out-of-pocket limit compared to Plan K.
While Plan K pays 50% of a service — like with Part A deductibles and Part B coinsurance — Plan L will cover 75% of these costs. Otherwise, these plans cover — and don’t cover — the same services. Additionally, the Plan L annual out-of-pocket limit is half the Plan K out-of-pocket limit.
When to Buy Plan K
Certain periods of time are ideal for signing up for Plan K — or any other Medigap plan for that matter. While you can try and purchase a Medigap plan at any point during the calendar year, there is no guarantee that an insurance company will sell you a plan.
On the other hand, if you enroll in a Medigap plan during your six-month Medigap open enrollment period that you are granted when you first enroll in Parts A and B, you will have the most favorable set of circumstances. Insurance companies have to sell you a plan during this time and can’t charge you more because of any medical conditions.
If you are able to buy a plan outside of this window, you may have to pay more, or you may be refused a plan due to medical conditions or other criteria.
Can anyone buy Plan K?
Can I add Plan K to my Medicare Advantage plan?
Is there a set price for Plan K?
Can I use my Medigap plan for any out-of-pocket medical expenses?
Have questions about your Medicare coverage?
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- Costs of Medigap Policies. Medicare.gov.
- K & L Out-of-Pocket Limits Announcements. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.