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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