Medicare Supplement Plan K: The Ultimate 2021 Guide

Medicare Supplement Plan K
Key Takeaways

Medicare Supplement Plan K is one of the most popular medical supplement insurance plans.  Given that it limits your annual out-of-pocket costs, it is particularly attractive to those with chronic conditions.

If you are eligible for the Federal Medicare Program (Parts A & B, also referred to as Original Medicare), you can purchase a Medicare supplement insurance plan. With many plans to choose from (ten different plans, as of 2021), it can be challenging to know which plan to select and which private insurance company to buy from.

In this article, we will discuss what Medicare Supplement Insurance is at a general level, followed by a detailed review of the benefits of Medigap Plan K.

What Are Medicare Supplement Insurance Plans?

Medicare supplement plans are issued by private health insurance companies and help pay for costs not covered by Original Medicare (Part A and Part B).  These include:

  • Copayments and coinsurance
  • Deductibles
  • Total out-of-pocket costs

Because they help fill in the gaps not covered by Medicare, supplemental plans are often called “Medigap” plans.

There are ten different types of Medigap policies (Plans A, B, C, D, F, G, J, K, L, M, and N).  In some states, Plans F and G also have a high-deductible option, which combines health insurance coverage with a savings component through an HSA (health savings account).

Plans F & G provide prescription drug coverage; however, you can also purchase Part D prescription drug coverage on a standalone basis.

Medicare Supplement Insurance Plan K

Medicare Supplement Plan K covers services similar to other Medicare Supplement insurance policies, but instead of paying all your costs, the plan pays a percentage.

If you have a serious illness or injury, you have the protection of an out-of-pocket annual limit.  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.

This plan is a good option if you prefer a lower premium but still want a fair amount of coverage for a wide variety of services.

Medicare Plan K Benefits

We will dive into these benefits at a deeper level in the tables below, but at a high level, Medicare Supplement Plan K coverage provides:

  • 100% coverage for Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end
  • 50% hospice coverage for Part A coinsurance
  • 50% of Medicare-eligible expenses for the first 3 pints of blood
  • 50% Part B coinsurance, except for preventive care services, which are covered 100%

In addition to these basic benefits, Plan K also provides:

  • 50% coverage for Skilled Nursing Facility coinsurance
  • 50% coverage for your Medicare Part A deductibles
  • $6,220 out-of-pocket annual limit for 2021 (this limit adjusts each year for inflation)

Medicare Plan K Cheat Sheet (Printable PDF)

If you’re looking for a quick reference to Medicare Supplement Plan K benefits, click here for a printable PDF cheat sheet.

Medicare Plan K:  Basic Costs

ServiceYou Pay
Part A Inpatient Hospital Deductible50% ($742)
Annual Part B Deductible100% ($203)
Out of Pocket Maximum$6,220
Part B Excess ChargesNot Covered

If you have Plan K, you will be responsible for 50% of your $1,484 Part A deductible (or $742).

Like all Medicare Supplement plans available to new Medicare enrollees, Plan K does not cover your Part B deductible ($203).

While Part B excess charges are not covered, this should not influence your decision, as Part B excess charges are rare (and illegal in 8 states: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont).

Medicare Plan K:  Doctor Visits

ServiceYou Pay
Primary Care Visits10% Coinsurance
Specialist Visits10% Coinsurance
Referral To Specialist Required?No
Provider Network Required?No
Preventive ServicesAll costs above Medicare-approved amounts

For doctor visits, you are well-covered with Plan K.  For both primary care and specialist visits, you will pay only 10% coinsurance.

Unlike Medicare Advantage plans, with Medigap plans (like Plan K), you are not limited to a provider network, and you do not need a referral to see a specialist.

Medicare Plan K:  Emergency Care

ServiceYou Pay
Urgent Care10% Coinsurance
Emergency Care10% Coinsurance
Ground Ambulance Services10% Coinsurance
Air Ambulance Services10% Coinsurance
Foreign Travel EmergencyNot Covered

Coverage for urgent and emergency care is similar to that for doctor visits.

For urgent or emergency care as well as ground or air ambulance services, you will pay only 10% coinsurance.

Note that Plan K does not cover foreign travel emergency care, so if you are planning significant international travel, you may want to consider plans that provide this coverage (e.g., Plan G).

Medicare Plan K:  Inpatient Care

ServiceYou Pay
Inpatient Hospital CareFor Days 1-60: $742;
For Days 61-90: $0;
For Days 91+: $0 for first 425 days, then all costs
Skilled Nursing FacilityFor Days 1-20: $0;
For Days 21-100: Up to $92.75 per day;
For Days 101+: All costs

When your Medicare Part A hospital benefits are exhausted, the insurer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Medicare Plan K:  Outpatient Care

ServiceYou Pay
Ambulatory Surgical Center10% Coinsurance
Outpatient Hospital Services10% Coinsurance
Mental Health - Outpatient10% Coinsurance

Outpatient care is covered similarly to doctor visits and urgent/emergency care: you pay 10% coinsurance, and your medicare supplemental insurance covers the rest.

Medicare Plan K:  Lab & X-Ray Services

ServiceYou Pay
Lab Services$0
Diagnostic Radiology Services10% Coinsurance
Outpatient X-Rays10% Coinsurance
Durable Medical Equipment10% Coinsurance

Lab services are not subject to the Part B deductible and are paid at 100% by Medicare.

 

Medicare Plan K:  FAQs

Medicare Supplement Plan K covers services similar to other Medigap plans, but instead of paying all your costs, the plan pays a percentage. The key benefit of Plan K is that there is an annual limit on your out-of-pocket costs, which can be a lifesaver if you have a serious illness or injury.
Generally, Plan K insurance has lower monthly premiums, but involves higher coinsurance amounts and a higher annual out-of-pocket limit than Plan L.

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