If you have Original Medicare and need some additional coverage to help lower your out-of-pocket costs, a Medigap plan might be a solution. In the United States today, over 14.5 million Medicare beneficiaries get additional coverage from a Medicare Supplement Insurance (Medigap) plan. These plans are sold by private insurance companies and are available to purchase by people who are enrolled in Original Medicare Parts A and B and meet the criteria.
If you have a Medigap plan, your Medicare insurance remains your primary payer. First, Medicare pays its share of any of your health care costs that are Medicare-approved, and then Medigap covers its share. You must pay any costs that are left after Medigap pays.
Today, there are 10 Medigap plans that are standardized according to the letters: A, B, C, D, F, G, K, L, M, and N, but Plans C and F are no longer available for Medicare beneficiaries who were new to Medicare after January 1, 2020.
Medigap plans are standardized so enrollees can get the same benefits no matter what insurance company sells them. All 10 plans cover 100 percent of the Medicare Part A coinsurance and hospital costs for additional days, as well as 50 to 100 percent of other common Medicare costs.
One of the popular Medigap plans for newly retired Medicare recipients who are relatively healthy and on a restricted budget is Plan K. If you’ve been considering this plan, here’s a look at what it covers.
What does Medicare Supplement Plan K cover?
Like all Medigap plans, Plan K helps you cover some out-of-pocket expenses associated with Original Medicare Parts A (hospital insurance) and B (medical insurance), but Plan K only covers a portion of the cost rather than the total cost. Here’s a list of everything that Medigap Plan K covers:
- 100 percent of Part A coinsurance and hospital costs for up to 365 additional days after your Medicare benefits end.
- 50 percent of your Part B coinsurance or copayment charges.
- 50 percent of the cost for the first three pints of blood you may need during a surgical procedure or emergency care.
- 50 percent of Part A hospice care coinsurance or copayments.
- 50 percent of skilled nursing facility care coinsurance charges.
- 50 percent of your Part A deductible for each applicable benefit period.
Unlike some other Medigap plans, Plan K doesn’t cover Medicare Part B excess charges or foreign travel exchange costs.
However, Medigap Plan K does have an out-of-pocket limit that most other plans don’t have. For example, if you have Plan K coverage in 2023 and you pay at least $6940 for Medicare expenses out-of-pocket, then your plan begins paying 100 percent for all your covered services for the rest of that year.
Medigap Plan K is a budget-friendly plan with reduced coverage. Depending on your health care needs, you might not need a more comprehensive plan right now, but you should consider future medical needs.
In most cases, you’ll have a guaranteed issue right to buy any Medigap plan sold in your state within the six-month Medigap Open Enrollment Period which starts when you turn 65 and are enrolled in Part B. During the Medigap Open Enrollment Period you have a 30-day free look period to decide whether to keep the plan you’ve purchased. If you decide to switch, don’t cancel the initial plan until you are certain you want to keep the second plan. Even though you’ll have to pay two premiums for one month, you won’t lose your right to coverage.
If you’re considering enrolling in a Medigap plan, you should explore all your options beforehand. Discuss these options with a licensed independent sales agent who can help you compare plans and find the one that’s right for your health care needs as well as for your budget.