Plan K is different than many other Medigap options. As opposed to fully covering a particular Medicare out-of-pocket expense (e.g. the deductible for hospital services), Plan K often pays a percentage of that cost. The table below illustrates this benefit tendency within Plan K.
|Plan K Coverage|
|Medicare Part A Deductible||50% coverage|
|Medicare Part B Deductible||No coverage|
|Medicare Part B “Excess Charges”*||No coverage|
|Copayment or Co-Insurance Fee for Medicare Part B services||50% coverage|
|Part A Co-Insurance Fees & Hospital Costs for up to 365 days after Original Medicare Benefits are Exhausted||100% coverage|
|Cost of first 3 Pints of Blood||50% coverage|
|Copayment or Co-Insurance Fee for Medicare Part A Hospice Care||50% coverage|
|Co-Insurance Fees for Skilled Nursing Facility Care||50% coverage|
|Foreign Travel Medical Emergency Coverage (up to plan limits)||No Coverage|
|Annual Limit on Enrollee Out-of-Pocket Expenses?||$4,940|
Plan K has an annual out-of-pocket limit of $4,940. This means that once out-of-pocket costs reach this limit, the plan fully pays for all remaining out-of-pocket costs for covered services until the beginning of a new calendar year. Plan K is one of only two Medigap Plans that have an annual limit on Medicare out-of- pocket costs. Plan L is the other Medigap option with this feature.
Plan K may be well-suited to those Medicare beneficiaries who want to protect themselves from catastrophic out-of-pocket costs but don’t mind the prospect of paying almost $5,000 if they have heavy healthcare use in 2016.
If you desire coverage for all the out-of-pocket costs listed in the above table, you may want to investigate Plan F.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)