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.
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