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Medicare Supplement Insurance Plan K

Medicare Supplement Insurance, also known as Medigap, helps pay some of the costs that Original Medicare doesn’t cover, like:

  • Deductibles
  • Copays
  • Coinsurance

Original Medicare and Medicare Supplement Insurance work together:

  • First, Original Medicare (Part A and Part B) pays its share of the Medicare-approved amount for your covered health care costs
  • Then, your Medicare Supplement Insurance pays its share

You can buy Medigap policies through private insurance companies. There are several different Medicare Supplement plans, so you can choose the one that fits you best.

Partial Benefits, Yearly Out-of-Pocket Spending Limit

Medigap Plan K offers 50% coverage for most of the types of benefits. Plan K covers 100% of the Medicare Part A hospital coinsurance benefit. If you are interested in Plan K, be sure to ask if it’s available where you live.

Plan K is a good option for those who receive frequent medical care and tend to have high out-of-pocket costs. Also keep in mind that this plan requires you to pay a lot of costs up-front.

Plan K Covers 100% of the Cost of Part A hospital and coinsurance costs (up to an additional 365 days after your Original Medicare benefits are exhausted).

Plan K Covers 50% of the Cost of These Benefits:

  • Part A deductible
  • Part B coinsurance costs for preventive care
  • Part B copays or coinsurance
  • First three pints of blood for an approved medical procedure (yearly)
  • Part A hospice care copays or coinsurance
  • Skilled Nursing Facility (SNF) coinsurance

Important note: Plan K does not cover the Part B deductible and Part B excess charges. This means that if you choose Plan K, you must pay 100% of both the Part B deductible and Part B excess charges. Also, Part K does not cover emergency medical care when you’re traveling outside the United States.

Medicare Supplement Plans generally don’t cover long-term care, private-duty nursing, vision care, dental care, hearing aids and eyeglasses.

Maximum Out-of-Pocket Spending Limit

Plan K offers a benefit that most Medigap policies don’t. Plan K puts a cap on your yearly out-of-pocket spending limit, which may be important to you. In 2018, this out-of-pocket spending limit is $5,240 – as long as your medical expenses are for Medicare-covered services. This means that if you choose Plan K and you reach this limit (and you meet the Part B deductible), the plan will pay 100% of your covered services for the rest of the year. Original Medicare (Part A and Part B) does not have an out-of-pocket limit. This benefit helps you control the amount you are responsible to pay, especially if your medical costs are high.

Medicare Supplement vs. Medicare Advantage

It’s important to know that a Medicare Supplement Plan is different from a Medicare Advantage Plan. A Medicare Advantage Plan is another way to receive Medicare benefits. A Medicare Supplement Plan (Medigap policy) works together with your Original Medicare benefits and supplements them. Before you decide which option fits your needs, it’s a good idea to read about these choices and talk with a Medicare specialist.

Things to remember:

  • You must have Original Medicare (Part A and Part B)
  • You must continue to pay your Part B premium
  • You will also pay a monthly premium for your Medigap policy
  • You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one
  • Your Medigap policy cannot be canceled by the insurance company as long as you pay your monthly premium
  • Medigap policies are not allowed to offer prescription drug coverage

For more information:

  • Visit Medicare.gov
  • Contact the private insurance companies that sell Medigap policies
  • Call 1-800-MEDICARE (1-800-633-4227) (TTY: 711) 24 hours a day, seven days a week
  • Call your State Health Insurance Assistance Program (SHIP)