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Understanding Medicare Supplement Plan K
Medicare Supplement Insurance, sometimes referred to as Medigap, covers some of the out-of-pocket costs that you would normally have to pay with Medicare Parts A and B (Original Medicare). Individuals on a tighter budget and in excellent health may find Medicare Supplement Plan K (also referred to as Medigap Plan K) to be a good option. Plan K is one of eight standardized Medicare Supplement Insurance plans available for purchase in most states. (Massachusetts, Minnesota, and Wisconsin have their own standardized Medigap plans).
What does Medicare Supplement Plan K cover?
Medicare Supplement Plan K features lower premiums because it covers less of your healthcare expenses (coinsurance and copayments). The percentage of coverage is lower compared to other Supplement Plans, but you can expect to realize lower premium costs compared to other Medigap plans that cover more benefits or a greater percentage of costs.
Hospital Expenses: Pays Part A coinsurance and hospital costs, up to 365 days after Original Medicare benefits are exhausted.
Pays Part A coinsurance and hospital costs, up to 365 days after Original Medicare benefits are exhausted.
Medical Expenses: Pays 50% Part B coinsurance or copayment, except for preventive care services, which are covered 100%.
Pays 50% Part B coinsurance or copayment, except for preventive care services, which are covered 100%.
Transfusions: Pays 50% of Medicare-eligible expenses for the first three pints of blood.
Pays 50% of Medicare-eligible expenses for the first three pints of blood.
Hospice Care: Pays 50% of hospice coverage for Part A coinsurance or copayment.
Pays 50% of hospice coverage for Part A coinsurance or copayment.
Skilled Nursing: Pays 50% for facility care coinsurance.
Pays 50% for facility care coinsurance.
Additional Hospitalization Expenses: Pays 50% coverage for your Medicare Part A deductibles.
Additional Hospitalization Expenses
Pays 50% coverage for your Medicare Part A deductibles.
Part B Deductible: The Medicare Part B deductible for 2021 was $203. After the deductible is met, you pay 20% of the Medicare-Approved Amount (this is the amount a doctor or supplier that accepts assignment can be paid in Original Medicare) for most doctor services, outpatient therapy and durable medical equipment.1
Part B Deductible
The Medicare Part B deductible for 2021 was $203. After the deductible is met, you pay 20% of the Medicare-Approved Amount (this is the amount a doctor or supplier that accepts assignment can be paid in Original Medicare) for most doctor services, outpatient therapy and durable medical equipment.1
Part B Excess Charges: Providers who don’t accept Medicare assignment may charge up to 15 percent more than what Medicare is willing to pay, known as Part B excess charges. Medicare assignment is the Medicare approved cost for a particular medical service. Medicare assignment is accepted by Medicare-approved providers.
Part B Excess Charges
Providers who don’t accept Medicare assignment may charge up to 15 percent more than what Medicare is willing to pay, known as Part B excess charges. Medicare assignment is the Medicare approved cost for a particular medical service. Medicare assignment is accepted by Medicare-approved providers.
Foreign Travel Medical Emergencies: In most cases, Medicare won’t pay for health care or supplies you get outside of the U.S.
Foreign Travel Medical Emergencies
In most cases, Medicare won’t pay for health care or supplies you get outside of the U.S.
Prescription Drugs: Medigap Plan K does not cover prescription drugs. However, you can buy an additional Medicare Prescription Drug plan to cover prescription drug costs.
Medigap Plan K does not cover prescription drugs. However, you can buy an additional Medicare Prescription Drug plan to cover prescription drug costs.
Who can benefit from this type of supplement plan?
You should consider Plan K if you want a lower premium but still want the peace-of-mind of having a moderate amount of coverage for a wide variety of medical services in case of unexpected medical emergencies, or for those with chronic health conditions that require a lot of ongoing medical care.
Learn Why Jerry Chose Medicare Supplement Plan K
Jerry is 70 years old and in terrific health. He makes sure to get all his annual check-ups and tests and is regularly pronounced “the picture of good health.” He doesn’t need a lot of additional medical care and doesn’t anticipate requiring it anytime soon.
He’s retired though, so he wants to keep a lid on his premiums should he need some unexpected medical care. Anticipating his good health will continue, it’s okay with Jerry if his supplement plan doesn’t pay as big a percentage of his excess expenses as some of the other plans.
What’s most important to Jerry is having a supplement plan that features a cap on his out-of-pocket expenses.
For these reasons, Jerry chose Medicare Supplement Plan K.
Advantages to Medicare Plan K
Some Medicare Supplement Plan K benefits advantages to Medicare Plan K include:
- Lower premiums.
- Limits the amount of out-of-pocket you pay each year, which was $6,220 in 2021.
Drawbacks to Medicare Plan K
On the other hand, some drawbacks to Medicare Plan K, include:
- Covers less of your healthcare expenses like coinsurance and copayments.
Medicare Supplement Plan K Costs
Monthly premiums are set by the private insurance companies who offer Medicare Supplement Insurance and are based on age, health status, gender and various other factors. Depending on these factors including location, insurance companies may charge different premiums for the same Medicare Supplement Plan K. That’s why it is in your best interest to shop around to ensure you are paying the lowest amount possible for your Medigap coverage. Companies may not cancel your coverage unless you don’t pay the plan premium, you weren’t truthful on the application, or the Medigap insurance company becomes bankrupt or insolvent.
How Pricing Works For This Plan
Pricing for Medicare Supplement Plan K varies by Medicare insurance carrier. Medigap policies can be priced in 3 ways: community-rated, issue-age-rated, and attained-age-rated.
- Community-rated: For community-rated priced plans, generally the same monthly premium is charged to everyone who has the Medigap plan, regardless of age.
- Issue-age-rated: An issue-age-rated policy premium is based on the age you were when you bought the Medigap plan. Premiums are lowered for people who buy at a younger age and won’t change as you get older. Premiums may go up because of inflation and other factors, but never because of your age.
- Attained-age-rated: Attained-age-rated policy premiums are based on your current age, increasing your premium as you get older. Premiums are lower when you are younger, but continually increase as you age. Premiums may also increase because of inflation or other factors.2
When to Enroll in Medicare Supplement Plans
When you’re first eligible: The best time to enroll in a Medicare Supplement plan is when you’re first eligible. You are eligible to purchase a Medicare Supplement policy (Medigap) on the first day of the month in which you turn 65. This marks the beginning of your Medigap Open Enrollment Period which lasts for six months.
You must already be enrolled in Medicare Part A and Part B. During this period, you can buy any Medigap policy sold in your state, regardless of any health problems. You will generally see better prices and more choices among Medigap policies during this period.
Outside open enrollment: While it’s often better to get coverage when you’re first eligible, you can still apply for Medigap coverage after your initial enrollment period. However, if you apply for coverage after your initial enrollment period, there’s no guarantee that an insurance company will sell you a policy if you don’t meet the medical underwriting requirements.
FAQs About Medicare Supplement Plan K
Below are answers to some frequently asked questions about Medicare Supplement Plan K.
What is the out-of-pocket limit for Medicare Plan K?
Plan K does limit the amount of out-of-pocket you pay each year, which is $6,220 in 2021. This is helpful since Original Medicare does not have an annual out-of-pocket limit, so there’s no maximum cap on your healthcare costs for a given year. Once you reach this “cap” on your out-of-pocket costs, the plan pays 100% of Medicare-approved costs for the rest of the year.
How can I lower the costs of my Medigap Plan K?
Since the cost of Medigap plans vary by insurance company, it’s important to shop around. By working with SelectQuote, we can compare all of your Medicare coverage options to find the right plan at a price that fits your budget.
Do Medigap plans vary by state?
Do Medicare Supplement plans cover pre-existing conditions?
While insurance companies can’t make you wait for your coverage to start, they may make you wait for coverage for a pre-existing condition. Coverage for pre-existing conditions can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medicare Supplement plan.
After the 6-month period, the Medicare Supplement plan will cover the condition that was excluded. However, it is possible to avoid or shorten the waiting period for a pre-existing condition if you buy a Medicare Supplement plan during your Medigap open enrollment period to replace “creditable coverage” Medigap plan.3
Compare Medicare Supplement Plans
There are a variety of Medicare Supplement plans available and the best way to figure out which could be right for you is by comparing the advantages and drawbacks. Learn more about the Medicare Supplement plan options below.
Find the Right Medicare Supplement Plan For You With SelectQuote
There’s a lot to consider when it comes to Medicare. At SelectQuote, we can help you navigate the Medicare Supplement plans available to you, understand costs and answer any questions you may have throughout the process.