What is 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.
Medigap Plan K, also called Medicare Supplement Plan K, helps cover expenses not paid by Original Medicare. Medigap Plan K is one of only two Medicare Supplement Insurance plans that feature an annual out-of-pocket maximum, limiting your healthcare spending each year. Read on to learn more about Medigap Plan K benefits.
Medigap At a Glance
Medicare Supplement Insurance plans, or Medigap, can help pay Part A and Part B costs including copayments, coinsurance, and deductibles. Purchasing a separate Medigap plan for an additional fee helps pay your portion of the out-of-pocket care costs after Medicare pays its share.
In most states, Medigap plans are distinguished by letter: Plans A, B, C, D, F, G, J, K, L, M, and N. Each letter is standardized. For example, all Plan K plans must offer the same benefits, regardless of which insurance companies offer them. However, different plan letters offer different coverages.
Once you purchase a Medigap plan, it will automatically renew each year as long as you keep paying your premiums. Note that Medigap plans are only compatible with Original Medicare. You cannot have both Medigap and Medicare Advantage.
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Understanding Medicare Supplement Plan K
Medigap Plan K pays a percentage of costs, like Part B coinsurance, Part A hospice care, and Part A deductibles up to the annual out-of-pocket limit. After beneficiaries meet their out-of-pocket limit, Medigap Plan K pays 100% of Medicare-approved care costs.
Key Features of Medigap Plan K
- Pays 50% of select covered services until you meet your annual out-of-pocket limit
- Requires lower monthly premium than most other Medigap plans
- Offered in every state except Massachusetts, Minnesota, and Wisconsin
- Benefits apply to any doctor or hospital that accepts Medicare
What Does Medigap Supplement Plan K Cover?
Medigap does not offer additional medical benefits. Instead, it helps cover certain out-of-pocket costs. Most notably, Plan K features an annual out-of-pocket maximum. This is the most you will pay for covered costs each year before Plan K covers all your eligible healthcare expenses for the remainder of the year. The Plan K out-of-pocket maximum is $7,220 for 2025.
Medigap Plan K also supplements your portion of the following costs from Original Medicare:
- Part A coinsurance and hospital costs for up to 365 additional days after Medicare pays
- 50% Part B coinsurance or copayment
- 50% blood benefits for first three pints
- 50% Part A hospice care coinsurance or copayment
- 50% skilled nursing facility coinsurance or copayment
- 50% Part A deductible
Costs For Medigap Plan K
Medigap Plan K generally involves higher coinsurance costs but lower monthly premiums. The following details how Medigap Plan K supplements the costs of Medicare:
- Premiums: Medigap plans have their own premium in addition to Original Medicare. Medigap premiums can vary based on when you enroll, where you live, and your health status. Enrolling when first eligible for Medigap generally gets you the most favorable rates.
- Deductibles: While Medigap Plan K does not offer coverage for Part B deductibles, it does pay 50% of Part A deductibles. Because Plan K has less coverage for deductibles than many other Medigap plans, premiums tend to be lower to compensate.
- Copays: Medigap pays 50% of copay costs for Medicare Part B, which includes set rates for routine and preventive medical services. It also covers Part A hospice care.
- Coinsurance: Coinsurance is the percentage of costs you share with Original Medicare. For example, Part B generally covers 80% of eligible care costs, leaving you to pay the remaining 20% out of pocket. Medigap Plan K covers coinsurance hospital costs for up to one year after Medicare Part A benefits are exhausted, and 50% of coinsurance costs for Part B, Part A hospice care, and skilled nursing facility care.
- Out-of-pocket maximum: The out-of-pocket maximum is a cap on how much you will pay each year on eligible health expenses. Original Medicare does not have an out-of-pocket maximum, which can get costly if you have recurring health needs. Plan K features an out-of-pocket maximum of $7,220 for 2025, so once you have paid that in eligible expenses, Plan K will cover all of your Medicare costs for the rest of the year.
See It In Action
While everyone’s needs and circumstances are different, Medigap Plan K can especially benefit those seeking lower Medigap premiums and a cap on annual out-of-pocket expenses. Consider a scenario where you have already met your deductible and your medical bill is $300. Here is a sample breakdown of Medigap Plan K coverage for copay and coinsurance costs:
| Out-of-Pocket Cost With Medicare Only | Out-of-Pocket Cost With Plan K | |
|---|---|---|
| Copay | $30 | 50% of $30 ($15) |
| Coinsurance | 20% of $300 ($60) | 50% of $60 ($30) |
| TOTAL | $90 | $45 |
Keep in mind that this is an example based on in-network provider costs to illustrate the difference in potential care estimates. Actual figures will vary by plan and healthcare provider.
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How Medicare Supplement Plan K Compares With Other Medigap Plans
| Benefits | Plan K | Plan L | Plan A |
|---|---|---|---|
| Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes |
| Part B coinsurance or copayment | 50% | 75% | Yes |
| Part A hospice care coinsurance or copayment | 50% | 75% | Yes |
| Part A deductible | 50% | 75% | Not covered |
| Part B deductible | Not covered | Not covered | Not covered |
| Part B excess charge | Not covered | Not covered | Not covered |
| Out-of-pocket limit | $7,220 in 2025 | $3,610 in 2025 | N/A |
| Blood (first three pints) | 50% | 75% | Yes |
| Skilled nursing facility care coinsurance | 50% | 75% | Not covered |
| Foreign travel exchange up to plan limits | Not covered | Not covered | Not covered |
How to Choose a Medigap Plan
When choosing a Medigap plan, consider the following:
- Cost
- Coverage
- Insurer reputation
The right Medigap plan should be cost-effective and fit into your budgeting goals. Your monthly premiums and overall out-of-pocket costs are especially important when considering Medigap coverage to ensure your plan helps you save on expenses. Factor in the benefits each Medigap plan offers against your projected health needs and costs.
Beyond the Medigap plan’s price, consider whether you need more coverage for Part A or Part B benefits because some Medigap plans can make services more affordable. For example, Medigap Plan K covers a longer hospital stay than Original Medicare. Finally, after you have decided on a Medigap letter plan, look into each insurance carrier’s reputation, including consumer reviews and corporate ratings. Benefits are standardized, but customer reputation for service may vary across insurance companies.
How to Enroll in Medigap
To enroll in Medicare Supplement Plan K, you must first be enrolled in both Medicare Parts A and B. Once you are enrolled in both parts, your Initial Enrollment Period (IEP) begins for Medigap. This is separate from your Initial Enrollment Period for Medicare.
Your Medigap IEP lasts for the first six months you have active Medicare coverage. For example, if your Medicare coverage began in March, your Medigap IEP would run from March until August.
Medigap insurance carriers cannot deny you coverage based on your health status or a pre-existing condition during this period. After this period, you may enroll in Medigap at any time, but may be subject to medical underwriting requirements and higher costs for coverage at the discretion of your Medigap provider.
Putting It All Together
Medicare Supplement Insurance plans like Medigap Plan K can help you save on healthcare costs. Medigap Plan K offers extended Part A hospital benefits and places a cap on annual out-of-pocket expenses. Medicare Supplement Plan K also features affordable monthly premiums in exchange for partial benefits coverage, including Part B copays and coinsurance, Part A hospice copays and coinsurance, and Part A deductibles. Consider working with a licensed insurance agent or broker to learn more about your options.
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?
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- Costs of Medigap Policies. Medicare.gov.