Medigap Plan K is a Medicare Supplement Insurance plan that covers out-of-pocket expenses for Medicare Part A and Part B beneficiaries. Plan K is different from most other Medigap plan options because it only pays part of the cost of the services it covers, but it also helps keep premiums down.
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How it works.
Medicare Part A and Part B members can buy a Medigap plan to help pay for costs beyond their Original Medicare coverage.
Most states have 10 standardized Medigap plans, except for Massachusetts, Minnesota and Wisconsin, which use different standards. The plans have different levels of coverage for services, out-of-pocket limits and premium costs.
Plan K doesn't pay for all of the services it covers. It covers 50% of the cost of most services, so you wouldn't have to pay the other 50%. Plan K is one of only two Medigap plans with an out-of-pocket limit, and it pays 100% of its covered services for the rest of the year.
According to Medicare.gov, Medigap Plan K covers the following.
After Medicare benefits are used up, the cost of Part A and hospital can be increased.
Part A is deductible.
Part A of Hospice care has a copayment.
Part B copayment or coinsurance is 50%.
The coinsurance for skilled nursing facility care is 50%.
The first three quarts of blood are needed for a blood transfusion.
There is an annual out-of-pocket limit.
Medigap Plan K doesn't cover everything.
The benefits that Medigap Plan K doesn't cover are included in other plans.
Medicare Part B excess charges are when a provider charges you more than the approved amount.
Emergency care is available outside the US.
Plan K, sold to new Medicare members, doesn't cover the following:
New Medicare members can't buy any plan that covers the Part B deductible since 2020
There are prescription drugs.
There is long-term care.
Dental work.
Vision care.
Private-duty nursing.
How much does Medigap cost?
Plan K has low premiums because it covers less. Private insurers set prices for this plan according to factors including age, location and tobacco use, which is regulated by the federal government. Monthly premiums for a 65-year-old nonsmoker in a California ZIP code range from $50 to $95.
You can find out what a Medigap Plan K plan would cost by visiting Medicare.gov.
If you enroll as soon as possible, you will get the best price for Medigap Plan K coverage. When you turn 65, you can enroll in Medicare Part B for six months. When setting your price, providers can't consider your medical history or health during those six months. You might be charged a higher price or denied coverage because of those considerations after the period ends.
You can ask questions about Medicare at Medicare.gov or by calling 800-633-4227.
Alex is a writer for NerdWallet. Email: arosenberg@nerdwallet.com Alex PRosenberg has a verified account.
What is Medigap plan K? What you need to know was first published on NerdWallet.
