Medicare Supplement Plan K is one of 10 different Medigap plans and one of the two Medigap plans that has a yearly out-of-pocket limit.

Medigap plans are offered in most states to help pay for some of the healthcare costs not covered by original Medicare (Part A and Part B). If you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies have slightly different letter names.

To qualify for any Medigap plan, you must be enrolled in original Medicare.

Let’s find out what Medicare Supplement Plan K covers, doesn’t cover, and whether it might be a good fit for you.

Medicare Supplement Plan K includes the following coverage for Medicare Part A (hospital insurance) and Medicare Part B (outpatient medical insurance) costs, as well as some extras.

Here’s a breakdown of the costs Medigap Plan K will cover:

  • Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted: 100%
  • Part A deductible: 50%
  • Part A hospice care coinsurance or copayment: 50%
  • blood (first 3 pints): 50%
  • skilled nursing facility care coinsurance: 50%
  • Part B coinsurance or copayments: 50%
  • Part B deductible: not covered
  • Part B excess charges: not covered
  • foreign travel exchange: not covered
  • out-of-pocket limit: $6,220 in 2021

When you have original Medicare and buy Medicare Supplement Plan K from a private company, your Medigap policy will pay its share of the Medicare-approved amount of covered healthcare costs after Medicare pays its share.

Medigap policies only cover one person. If your spouse qualifies for and wants a Medigap policy, you will have to buy separate policies.

One of the features that makes Medicare Supplement Plan K different from most other Medigap options is the yearly out-of-pocket limit.

With original Medicare, there is no cap on your annual out-of-pocket costs. Purchasing a Medicare Supplement Plan K limits the amount of money you will spend on healthcare during the course of a year. This is often important for people who:

  • have high costs for ongoing medical care, often due to a chronic health condition
  • want to avoid the financial impact in case of a very expensive unexpected medical emergency

How does the yearly out-of-pocket limit work?

Once you have met your yearly Part B deductible and your Medigap out-of-pocket yearly limit, 100% of all covered services for the rest of the year are paid for by your Medigap plan.

This means you should have no other out-of-pocket medical costs for the year, as long as the services are covered by Medicare.

The other Medigap plan that includes a yearly out-of-pocket limit is Medicare Supplement Plan L. Here are the out-of-pocket limit amounts for both plans in 2021:

  • Medicare Supplement Plan K: $6,220
  • Medicare Supplement Plan L: $3,110
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As previously mentioned, Plan K does not cover the Part B deductible, Part B excess charges, or foreign travel healthcare services.

Medigap policies also typically do not cover vision, dental, or hearing services. If you want this type of coverage, consider a Medicare Advantage (Part C) plan.

Additionally, Medicare supplement plans do not cover outpatient retail prescription medications. For outpatient prescription drug coverage, you’ll need a separate Medicare Part D plan or a Medicare Advantage plan with this coverage included.

Medicare Supplement Plan K coverage is one of 10 different Medigap plans to pay for some of the healthcare costs leftover from original Medicare coverage.

Along with Medicare Supplement Plan L, it is one of the two Medigap plans that include a cap on how much you will spend on Medicare-approved treatments.

Medicare Supplement Plan K does not include coverage for:

  • prescription drugs
  • dental
  • vision
  • hearing

This article was updated on November 13, 2020, to reflect 2021 Medicare information.

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