Original Medicare may pay up to 80% of your health services, having your Medigap policy cover the rest of the bill. Medigap is a Medicare supplement that fills in for the gaps that Original Medicare, also known as Medicare Parts A and B, does not cover. Gaps that Medigap may cover include deductibles, coinsurance, and copays.
What is Medigap Plan K?
Medigap Plan K is 1 of 10 Medigap policies that are offered by private insurance companies. However, not all 10 Medigap policies are available in every state, and private insurance companies may limit which plans they offer.
Plan K covers out-of-pocket expenses that are associated with Original Medicare Part A and Part B.
How Does Medigap Plan K Work?
Medigap Plan K may cover up to 50% of your medical services until you meet the out-of-pocket maximum, which is $6,940 in 2023. Once the maximum has been reached, Plan K may pay 100% of your services for the rest of the remaining year.
Those with high out-of-pocket costs may want to consider Plan K if their medical costs go over the annual limit of Plan K. You may find yourself with high out-of-pocket costs if you often go see a health specialist and frequently require medical services.
What Does Medigap Plan K Cover?
|Benefits||Plan K||Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan|
|Plan M||Plan N|
|Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||50%||Yes||Yes||Yes||Yes||Yes||Yes||75%||Yes||100% coinsurance; but copays may still apply|
|Part A hospice care coinsurance or copayment||50%||Yes||Yes||Yes||Yes||Yes||Yes||75%||Yes||Yes|
|Part A deductible||50%||Not covered||Yes||Yes||Yes||Yes||Yes||75%||50%||Yes|
|Part B deductible||Not covered||Not covered||Not covered||Yes||Not covered||Yes||Not covered||Not covered||Not covered||Not covered|
|Part B excess charge||Not covered||Not covered||Not covered||Not covered||Not covered||Yes||100%||Not covered||Not covered||Not covered|
|Out-of-pocket limit||$6,940 in 2023||N/A||N/A||N/A||N/A||N/A||N/A||$3,470 in 2023||N/A||N/A|
|Blood (first three pints)||50%||Yes||Yes||Yes||Yes||Yes||Yes||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||50%||Not covered||Not covered||Yes||Yes||Yes||Yes||75%||Yes||Yes|
|Foreign travel exchange up to plan limits||Not covered||Not covered||Not covered||80%||80%||80%||80%||Not covered||80%||80%|
Plan K covers:
- Part A deductible
- Part A coinsurance and copays for hospice care
- Medicare Part B coinsurance or copays
- First three pints of blood
- Skilled nursing home coinsurance
Bear in mind that Plan K may pay 50% of copays and coinsurance. Once you meet the out-of-pocket maximum, Plan K may pay 100% of your services for the rest of the year.
What Is Not Covered By Medigap Plan K?
Plan K may not cover your Part B deductible and Part B excess charges.
An excess charge means that a doctor may bill up to 15% more than what Medicare had approved for the original amount toward a procedure or examination. This usually occurs when a doctor is out-of-network.
Plan K, along with other Medigap policies, does not cover:
- Vision (Eyeglasses or eye exams)
- Dental (Dentures, teeth cleanings, or dental exams)
- Hearing aids
How Much Does Medigap Plan K Cost?
In 2022, the average cost for Plan K is $90, though rates are determined by an individual’s age, location, gender, and health. Plan K’s costs are lower in premiums compared to other Medigap policies. Cost may also vary by different insurers and plans. For example, Plan K may cost less than Plan G because Plan K’s out-of-pocket costs are higher.
Is Medigap Plan K tax-deductible?
Plan K’s premiums are considered health expenses, making Plan K tax-deductible above a certain threshold.
You may only deduct your medical premiums that exceed 7.5% of your adjusted gross income. If you meet this threshold, you may fill out a Schedule A (Form 1040) for taxes.
Examples of deductible medical expenses include:
- Payments to the doctor
- Payments for false teeth, eyeglasses, or hearing aids
- Payments for inpatient care or residential nursing home care
Medigap Plan K vs. Medigap Plan L
Both Plan K and Plan L are often compared to each other due to their similarities in benefits. The difference between the two plans is the cost-sharing percentage that they cover. Plan K provides 50% of coverage while Plan L provides 75% of coverage.
Once the annual out-of-pocket limit is reached, both Plan K and Plan L may pick up 100% of the medical bill.
The 2023 out-of-pocket limit for Plan K is $6,940, while Plan L’s is $3,470.
How To Buy Medigap Plan K
You may purchase Plan K during your initial enrollment period through a private insurance company. Your initial enrollment period begins three months before you turn 65 years old, the month of your birthday, and three months after your birthday.
You may also purchase Plan K during the Open Enrollment Period, which occurs between November 1 to January 15. Open Enrollment happens once a year and you may change, cancel, or switch insurance companies within this window of time.