If you’re looking for some help with certain Original Medicare costs and want a lower-cost Medigap plan with very basic coverage, then Medigap Plan K may work for your situation.
Medicare Supplement Plan K pays a percentage of most of its covered benefits, with the exception of Medicare Part A coinsurance and hospital costs for an extra year (after you’ve used up what Original Medicare covers); Medigap Plan K covers this benefit in full. Because your out-of-pocket costs tend to be higher with this policy, Medigap Plan K typically comes with a lower premium than most other Medigap policies.
Medicare Supplement Plan K out-of-pocket limit
Medigap Plan K is one of two Medigap plans that includes a yearly out-of-pocket limit, which is $4,960 in 2016. After your out-of-pocket costs have reached this limit (which includes the yearly Part B deductible), Medigap Plan K may cover 100% of your Medicare-covered costs for the rest of the year. As a reminder, Original Medicare doesn’t come with an annual out-of-pocket limit, so there’s no maximum cap on your health-care costs for a given year. The yearly out-of-pocket limit can be helpful if you want to be protected against high out-of-pocket costs – either because you have a chronic health condition that requires a lot of ongoing medical care, or you simply want to be prepared in case of an unexpected medical emergency.
Keep in mind that the yearly out-of-pocket limit for Medigap Plan K is around twice the amount as the maximum out-of-pocket limit for Medigap Plan L, the only other Medigap plan that covers this benefit. If you want a Medigap plan that includes a yearly out-of-pocket limit, but would prefer to have a lower threshold before the plan begins to cover costs, then Medigap Plan L could be another option with a much lower limit: The annual out-of-pocket for Medigap Plan L is about half the amount as the limit for Medigap Plan K.
Medicare Supplement Plan K benefits
As mentioned, Medigap Plan K offers partial coverage for a variety of Original Medicare costs that you’d normally have to pay out of pocket. This plan covers 50% of the cost for the following benefits:
- Medicare Part A deductible
- Medicare Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Medicare Part B copayment or coinsurance
- First three pints of blood for a covered medical procedure (yearly)
With Medigap Plan K, beneficiaries must pay the Medicare Part B deductible and Part B excess charges out of pocket. Part B excess charges are the difference between what Medicare covers for a service and what your health-care provider may charge you. For every covered service or item, Medicare has set an “approved amount” that it will pay. However, some doctors may charge above this Medicare-approved amount, and the beneficiary is responsible for paying what Medicare doesn’t cover.
There’s a maximum limit that providers can charge above what Medicare will cover. Doctors and physicians who don’t accept assignment (meaning they don’t accept the Medicare-approved amount as full payment) are allowed to charge up to 15% over the Medicare-approved cost for their services. These “excess charges” are the responsibility of the beneficiary once Medicare pays its approved amount.
As an example, you’ll usually pay 20% of the Medicare-approved cost for outpatient services, while Medicare pays the remaining 80%. Let’s say the approved amount set by Medicare is $100 for a doctor appointment. A doctor who doesn’t accept assignment may choose to charge up to 15% over this amount, or $15 in excess charges. In this situation, Medicare will cover 80% of the cost, or $80. However, the beneficiary would be responsible not only for paying the remaining $20, but the additional $15, for a total out-of-pocket cost of $35. While Medigap Plan K doesn’t cover Part B excess charges, Medicare Plan Medicare Plan G and Plan F do if you are interested in this benefit.
As mentioned, while Medigap Plan K offers partial coverage for most of its benefits, the plan completely covers the following benefit:
- Medicare Part A coinsurance hospital costs up to an additional 365 days after Medicare benefits are exhausted
Medicare Supplement Plan K costs
One factor to keep in mind with Medigap Plan K is that you may have higher out-of-pocket costs with this Medigap policy. Because the plan only covers 50% of most of its benefits, you’ll still be responsible for paying half the cost for the first three pints of blood, the Part A deductible; and cost sharing for Part B-covered services, Part A hospice care, and skilled nursing facility care. On the other hand, you may find that Medigap Plan K policies in your service area tend to have lower premium costs than other Medigap plans that cover more benefits or a greater percentage of costs.
Since every person’s situation is different, it may be a good idea for you to start by estimating your typical out-of-pocket costs, given how frequently you see a doctor or require certain health-care services. You may find that you only need minimal help with certain health-care costs, in which case the basic coverage of Medigap Plan K may be enough for your needs. If you find that your medical expenses are higher than you like and want more coverage, other Medicare Supplement plan options may also be available for only a slightly higher cost, depending on your service area and location. eHealth has a plan finder tool that makes it easy to compare Medigap plans side-by-side; you can also take a look at this detailed Medigap chart, which compares plan benefits across all 10 Medicare Supplement plans.
Remember that as you compare plans, benefits are standardized across Medigap plans of the same letter category, regardless of location or insurance company. When making this important decision it is important to remember to meet with an agent that specializes in Medicare Supplement insurance so you can make the right decision.
If you have a question please call Stephen or Carla Fowler at 205-417-5027. They are Medicare Advisors with Prosurity. They can explain the Medicare system and help answer any of your questions.