Whether you’re already on Medicare or planning to enroll soon, it’s important to think about your coverage options. While Original Medicare covers the majority of your medical expenses, you still have to pay copays, deductibles, and the 20% Part B coinsurance. Meaning you’re at risk of receiving large bills. Plan K is a standardized Medicare Supplement Plan that works in tandem with Original Medicare to protect you from those bills.
Medicare Supplement Plan K is a Medicare Supplement Plan that pays for many out-of-pocket expenses associated with Medicare Parts A and B coverage. But Plan K, unlike most Medicare Supplement Plans, does not pay for 100% of the costs it covers. It only covers half of most costs, so you’ll still have to pay the other half out-of-pocket.
With that being said, Plan K is one of only two Medicare Supplement Plans with an annual out-of-pocket limit. In 2023, after you pay $6,940 out-of-pocket, the plan will pay for 100% of its covered services for the rest of the year.
What Plan K Covers
As we pointed out above, Medicare Supplement Plan K reduces your Original Medicare out-of-pocket expenses. But it does not completely fill the gaps. Plan K only pays 50% of some expenses until you reach your out-of-pocket maximum. In 2023, the maximum you’ll pay out-of-pocket for Plan K is $6,620. Once you’ve reached this limit, Medicare Supplement Plan K will cover the remainder of your approved costs for the rest of the year. The maximum resets at the start of each calendar year.
Plan K covers 50% of:
- Medicare Part B coinsurance – Medicare Part B typically charges a coinsurance for doctor visits and other outpatient care. In most cases, Medicare Part B pays 80% of the Medicare-approved amount for covered services. Leaving you to pay the remaining 20% coinsurance. Plan K covers half of these costs, so you will have to pay 50% of that 20%. For example, if your doctor charges $100 for a service, Medicare will pay $80, Plan K will pay $10, and you will pay $10.
- First 3 pints of blood – Original Medicare only covers the fourth and following pints of blood. If you require blood while in the hospital, Plan K will cover half of the cost of the first three pints.
- Part A hospice care coinsurance or copayment – Hospice care provides medical treatment and care to patients who are nearing the end of their lives. Medicare covers these services, but copayments are a must. These copayments include $5 for each prescription for symptom and pain relief drugs. As well as 5% of the Medicare-approved amount for inpatient assisted living. Plan K will cover half of these expenses.
- Skilled nursing facility care coinsurance – Plan K covers half of the coinsurance for medical care provided in skilled nursing care facilities.
- Medicare Part A deductible – In 2023, the deductible for Medicare Part A is $1,600 per 60-day benefit period. Medicare Supplement Plan K will pay half of these deductibles. Plan K requires you to pay the Medicare Part B deductible, which is $226 in 2023.
While Plan K covers many expenses at only 50%, it actually covers all of the Medicare Part A cost-sharing measure known as coinsurance. If an inpatient hospital stay exceeds 60 days, Medicare Part A requires you to pay coinsurance. This is the only basic benefit that Medicare Supplement Plan K fully covers.
The 50% that Medicare Supplement Plan K covers can really make a difference. You will be responsible for the total out-of-pocket costs from Original Medicare if you don’t have a Medicare Supplement Plan. However, having this coverage ensures that you will never have to pay 100% of your Medicare-related costs.
What Isn’t Covered by Plan K?
Medicare Supplement Plan K does not cover the Part B deductible, which is $226 in 2023. It also does not cover Part B excess charges and foreign travel emergencies. If you never leave the country, not having coverage for emergencies in other countries will not be a problem.
Another thing to consider if you’re thinking about going with Plan K is how much your healthcare providers charge. If they charge more than what Medicare allows, you may be charged up to 15% of what Medicare would pay for the service. This charge is your Part B excess charges. Plan K does not cover Part B excess charges.
Additionally, all Medicare Supplement Plans only cover one person. If your spouse is eligible for Medicare and wants a policy, you will need to purchase separate policies.
The Cost of Medicare Supplement Plan K
The federal government regulates all Medicare Supplement Plans. But they are sold by private health insurance companies, which set prices based on factors such as age, location, and tobacco use.
In general, though, Plan K has lower premiums than other Medicare Supplement Plans because it covers less of your out-of-pocket expenses. Before choosing any Medicare Supplement Plan, including Medicare Supplement Plan K, you should carefully consider your options. Plan K exposes you to a higher amount of out-of-pocket costs. So if you choose it, make sure you’ll be able to pay them without breaking the bank.
Enrolling in Medicare Supplement Plan K
The best time to enroll in any Medicare Supplement Plan is during your Medicare Supplement Open Enrollment Period. Doing so will mean you have guaranteed issue rights, and insurance companies will not be able to deny you or charge you more for your plan because of your health. This will guarantee that you get the best possible price for coverage.
You only get one Medicare Supplement Open Enrollment Period, so make sure you take advantage of it. Your OEP begins when you are 65 and enrolled in Medicare Part B and lasts for 6 months. If you continue to work after the age of 65 and have a group employer plan, your six-month period begins when you stop working or no longer have that insurance.
Prices may rise after your Open Enrollment Period ends, or you may be denied coverage due to your health status or medical history.
If you currently have a Medicare Advantage plan and want to enroll in Medicare Supplement Plan K, you must first return to Original Medicare. This change can be made during the fall Annual Enrollment Period or the Medicare Advantage Open Enrollment Period in the first quarter of each year.
- Does Plan K cover vision care?
Medicare Supplement Plans only cover what Original Medicare covers. So, since Medicare doesn’t cover routine eye exams, Medicare Supplement Plans also do not cover them, including Plan K.
- Who would benefit most from Plan K?
Plan K is a lower-cost Medicare Supplement Plan option with lower monthly premiums, but less coverage than other plans. That means Medicare beneficiaries on a tight budget who see the doctor less frequently will benefit the most from this plan. You just have to remember you will be paying a bit more for services. Since Plan K only covers 50% of most out-of-pocket expenses.
Furthermore, if you rarely travel outside of the country, this plan may be a good fit. Unlike many Medicare Supplement Plans, Plan K does not cover any emergency medical expenses while traveling abroad.
- What is the difference between Plan K and Plan L?
Plan L offers more benefits and a lower out-of-pocket maximum than Plan K. While Plan K covers 50% of some out-of-pocket expenses, Medicare Supplement Plan L covers 75% until you reach the Plan L maximum out-of-pocket of $3,470 in 2023. If you prefer coverage similar to that of your employer’s health insurance plan and are not concerned about out-of-pocket costs, Plan K or Plan L may be a good fit.
- Does it matter which insurance company I choose?
The benefits of Medicare Supplement Plans are completely standardized, so they will be the same from company to company. All Medicare Supplement Plans, including Plan G, include the following guidelines:
- Benefits – You don’t need to be particularly worried about which company provides the best or most benefits. What Plan K covers will be the same regardless of which company you choose.
- Network – Medicare Supplement Plan insurers do not have their own provider networks. Their plans merely supplement your Medicare Parts A and B coverage, so can see any doctor who accepts Medicare. You don’t have to worry about if one company has a better provider network than another. Because your network is the nationwide Medicare network.
- Claims – Medicare Supplement Plan claims are highly automated. The coverage is simple to use, and most people never see any paperwork. Once Medicare has approved your claim, they will pay their portion and notify your insurer of the amount owed. Your insurance company must then pay the amount owed in accordance with Medicare’s instructions. Because of automation and standardization in this area, every company’s claims-paying history is equal.
While the government standardizes Medicare Supplement Plan benefits, the price of them is not. So, you will still need to do some research into different insurance companies to find the best price.
- What is Plan K’s out-of-pocket maximum?
While Plan K provides less coverage than other Medicare Supplement Plans, it does have one potentially appealing feature: an out-of-pocket spending limit.
The out-of-pocket limit is a yearly limit on your out-of-pocket expenses for covered services. In 2023, the annual out-of-pocket maximum for Plan K is $6,940. That is, once you have contributed $6,940 out of your own pocket, the plan will pay 100% of all covered services and items for the rest of the year.
Plan K is one of only two Medicare Supplement Plans with an out-of-pocket maximum. Because Original Medicare has no out-of-pocket limit, this is a strong selling point for this plan.
How EZ Can Help!
If you’re looking for a Medicare Supplement Plan, it is essential that you compare the benefits and costs of each one. That means doing a lot of research, which can take a long time, since you’ll have to call multiple insurance companies to get rate quotes.
But if you work with one of EZ’s agents, you can cut the time it takes to compare prices in half. Working with a licensed agent gives you access to multiple Medicare Supplement Plan carriers and plans in one place.
Your agent can explain the differences between each plan, in addition to offering your price comparisons. Furthermore, your agent can help you weigh out-of-pocket costs versus premium costs to determine which plan will be the most cost-effective for you in the long run. To begin shopping for a Medicare Supplement Plan, call us at 877-670-3602 today.