- Medicare Supplement (Medigap) Plan K helps cover some of your health insurance costs.
- Federal law ensures that no matter where you purchase Medigap Plan K, it will include the same basic coverage.
- The cost for Medigap Plan K may vary based on where you live, when you enroll, and your health.
A Medicare “plan” is different from the “parts” of Medicare — the parts are your covered services through the government, and the plans are optional supplemental insurance sold by private companies.
Medicare Supplement Plan K is designed to help with some of the out-of-pocket costs that come with original Medicare coverage. It is one of two Medicare supplement plans that offer a yearly out-of-pocket limit.
Take a look at some of the Medigap Plan K price ranges in a few cities across the United States for 2021:
|New York, NY
|Las Vegas, NV
As you can see, the average costs can vary significantly based on where you live. These ranges also represent the wide range of prices that are based on your age, sex, when you buy the plan, tobacco use, and other health factors.
Plan K monthly premiums
If you enroll in a Medigap plan, you’ll have to pay a monthly premium. This will be in addition to your Medicare Part B monthly premium. Because private insurance companies sell Medigap policies, monthly premiums will vary by policy. Companies can choose to set their premiums in a variety of ways.
The three main ways they set premiums are:
- Community rated. Everyone with the policy pays the same monthly premium, regardless of his or her age.
- Issue-age rated. Monthly premiums are set based on how old you are when you purchase your policy. Individuals who buy at a younger age will have lower monthly premiums.
- Attained-age rated. Monthly premiums are set based on your current age. Because of this, your premiums will increase as you get older.
Plan K deductibles
While Plan K covers the Medicare Part A deductible, it doesn’t cover the Medicare Part B deductible. Medigap policies typically don’t have their own deductible, including Plan K.
Plan K copays and coinsurance
Plan K covers copays and coinsurance associated with Medicare parts A and B. If you have a Plan K policy, you won’t be responsible for these costs.
Plan K out-of-pocket costs
There are some things that Medigap typically doesn’t cover, although this can vary by policy. When a service isn’t covered, you’ll need to pay the cost out-of-pocket.
Some examples of servicesthat often aren’t covered in Medigap policies are:
Plan K is one of the only Medigap plans that limits the amount you’ll spend per year out of your own pocket.
The out-of-pocket limit for Medicare Plan K is $6,220 in 2021. This means that once you pay your yearly Part B deductible and meet the Plan K yearly limit, the Medigap policy will pay 100 percent of Medicare-approved services for the remainder of the calendar year.
The Centers for Medicare & Medicaid Services (CMS) requires that insurance companies offer standardized Medigap plans. This means that Plan K offers the same coverage in Tennessee as it does in California.
Medicare requires Medigap plans to be standardized. This means they cover the same features throughout the country. Examples of what Plan K covers include:
- Part A coinsurance and hospital costs for up to 365 days after a person uses up their Medicare benefits
- 50 percent of the Part A deductible
- 50 percent of the costs of a person’s first 3 pints of blood
- 50 percent of Part A hospice care coinsurance or copayments
- 50 percent of the coinsurance for skilled nursing facility care
- 50 percent of a person’s Part B coinsurance or copayments
Plan K does not pay for some aspects that other Medigap policies may. Examples include the Part B deductible, Part B excess charges, and foreign travel exchange.
You must have original Medicare to purchase a Medicare supplement plan. Insurance companies can’t offer Medicare supplement plans to those with Medicare Advantage.
If you have original Medicare Part A and Medicare Part B, you can enroll in a Medigap plan. In addition to the premium you pay for Part B, you will pay a monthly premium for Medigap. You can’t share a policy with your spouse — you must each have your own policy.
The ideal time to apply for Medigap Plan K is during your Mediap initial enrollment period. This window begins on the first day your Part B coverage is effective and lasts for a 6-month period.
During your Medigap initial enrollment window, insurance companies can’t base your costs on pre-existing conditions and a company can’t refuse to offer you a policy. Otherwise, you can purchase a policy at any time, but the insurance company may require a medical examination first and they can refuse to cover you.
After this window, there may be times when you have “guaranteed issue” rights to purchase a policy. This could include if you lost coverage from your previous health plan. However, at this time, you may have to answer questions about your health history that could increase the plan’s cost.
Medicare doesn’t require insurance companies to offer every plan. If an insurance company chooses to sell Medigap policies, they must offer at least Plan A.
If you wish to purchase a Medigap plan, you have several options:
- Visit Medicare.gov and search for available Medigap plans in your state or by ZIP code.
- Call your State Health Insurance Assistance Program. Also known as SHIP, this agency helps people with counseling for available plans in your area.
- Call or visit an insurance agent with an insurance company you’d like a quote from for a Medigap policy.
When it comes to Medigap policies, it pays to shop around. Because the coverage is the same, trying to get a lower-cost policy can be helpful. Remember to ask how the insurance company prices the policy. If the policy is age-based, you may need to consider how your costs could change as you get older.
Medicare Plan K is one Medicare supplement plan option. The cost can vary based on location, when you enroll, how the insurance company prices its policies, and more. If you are interested in Medigap Plan K, it pays to shop around online, by phone, or in person.