Understanding Medicare Supplement Plan K Coverage and Costs
Medicare Supplement Plan K is one of twelve options for Medigap insurance. Like other Medigap plans, Plan K covers out-of-pocket expenses related to Original Medicare. Both Plan K and Plan L are different from other Medicare Supplement plans in a few ways. They generally have lower premiums, but only pay for a percentage of out-of-pocket costs, rather than the entire amount. To ensure enrollees don’t experience catastrophic costs, these plans also have maximum out-of-pocket costs.
Key takeaways:
Medicare Supplement Plan K one of ten Medicare Supplement plans available to Medicare recipients.
Medicare Supplement Plan K has a lower premium, but you’ll need to pay more for coinsurance and copayment charges.
Medicare Supplement Plan K has an annual maximum out-of-pocket cost ($7,060 in 2024).
Medicare is not one-size-fits-all. We suggest talking to one of our licensed Medicare Supplement Advisors to pick the Medicare coverage that's just right for your needs.
What are Medicare Supplement plans?
Medicare Supplement (also called Medigap) plans fill in the “gaps” in coverage left by Original Medicare. Original Medicare only covers 80% of covered services. Medicare Supplement plans help pay for some of the remaining 20% of costs, which include copayments, coinsurance, and deductibles.
Important note: Massachusetts, Minnesota, and Wisconsin offer a different set of standardized Medicare Supplement plans. These states do not offer a Medigap Plan K.
Benefits of Medicare Supplement plans
In general, Medicare Supplement plans give you more comprehensive coverage. They limit your out-of-pocket costs so that you can go to the doctor without worrying as much about what you’ll owe at the end of your visit or treatment.
Standardization
Every Medicare Supplement plan of the same type is identical in coverage—even if pricing is different. For example, all Plan Ks would provide the same benefits regardless of the premiums you pay or the insurance carrier who offers your plan.
No restrictive provider networks
Neither Original Medicare and Medicare Supplement restrict you to provider networks. This means that you can see any doctor who accepts Medicare nationwide. With access to about 90% of all doctors in the US, getting the care you need is easier. You can also see doctors in multiple states, which is great for snowbirds who live in warmer states during the winter!
No need for prior authorization
With Original Medicare and Medicare Supplement, won’t need to get prior authorization for covered services. This makes it easier to get quick access to the care you need. On the other hand, prior authorization has become a common complaint of Medicare Advantage plans.
Eligibility for Medicare Supplement plans
You are eligible for a Medicare Supplement plan if you are:
Enrolled in Original Medicare (Part A and Part B).
Not enrolled in Medicare Advantage.
Comparing Medicare Supplement plans
There are ten types of Medicare Supplement plans, and each plan covers a different set of out-of-pocket costs. For a deeper look at each of them, compare plans with this chart.
Navigating the different parts and plans of Medicare can feel complicated. If you need help comparing different plans and choosing the right one for you, our licensed Medicare Advisors are here to help! Give us a call at (855)-900-2427 for free advice based on your unique health and financial situation.
Medicare Supplement Plan K costs and coverage
Medicare Supplement Plan K is not a very popular plan—only 0.5% of beneficiaries were enrolled in a Plan K in 2023. Although the benefits of Plan K include lower premiums and a yearly out-of-pocket limit, the plan provides less coverage overall compared to other Medigap policies.
For a more comprehensive plan, learn about Plan G or Plan N. Plans G and N are the two most popular Medigap plans among Medicare beneficiaries because they provide the highest level of coverage at the best value.
What’s covered under Medigap Plan K?
Medigap Plan K covers 100% of the costs of:
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Medigap Plan K covers 50% of the costs of:
Part B coinsurance or copayments
Blood transfusion (up to 3 pints)
Part A hospice care coinsurance or copayments
Skilled nursing facility care coinsurance
Part A deductible
What’s not covered?
Medigap Plan K does not cover the following costs at all:
Part B deductible
Travel-abroad emergency medical care
Generally, Medigap only provides coverage for out-of-pocket costs leftover by Original Medicare. It will not cover additional healthcare needs like:
Long-term care and private nurses
Prescription drugs
Medicare Supplement Plan K out-of-pocket costs and maximums
Because Plan K pays for only 50% of most out-of-pocket costs and doesn’t cover costs that some other Medicare Supplement policies do, it does have a yearly out-of-pocket maximum. This puts an upward limit on the amount you’d have to pay for healthcare services each year, and ensures you won’t be responsible for catastrophic costs. The out-of-pocket maximum for Plan K is $7,060 in 2024. Once you reach this amount, Medigap will pay 100% of covered services for the rest of the calendar year.
Medicare Supplement Plan K premiums
How much you pay for your specific Medigap Plan K will depend on personal factors, where you live, and your insurance carrier. These specific factors determine the price of premiums:
Where you live
Your smoking status
Your age
Your gender
The insurance carrier
Household discounts (offered by some Medigap plans)
Your premium can change over time depending on how your insurance prices the plan. Your age, inflation, and other external factors could impact how much you pay. Read on to learn more.
Will my Medicare Supplement premium change over time?
Whether or not your premium increases over time depends on three pricing or “rating” structures:
Community-rated (aka no-age-rated): The premium you pay is the same as everyone else with the same policy, regardless of age. This means your premium will not increase as you age.
Issue-age-rated (aka entry age-rated): The premium you pay is based on the age you were when you first enrolled in your Medigap plan. This means your premium will not go up as you age.
Attained-age-rated: How much you pay is based on the age you currently are (the age you’ve “attained”). Your premium is generally lower at first and can increase as you get older.
How to enroll in a Medicare Supplement Plan K
The best time to enroll is during your Medigap Open Enrollment period, which lasts for six months after your Medicare Part B coverage starts. Outside of the period and a handful of other guaranteed issue periods, you may need to go through Medigap underwriting (answering questions about your health history) to apply—and your application could be denied. Learn more about how Medigap enrollment periods work here.
How to choose the right Medicare Supplement Plan
If you have more questions about Plan K, our Medicare Advisors can help you understand it and your other Medicare option. We’re here to help you make an informed choice regarding your Medicare coverage.
Schedule a free consultation or call us at (855) 900-2427.