If you need some assistance with some Original Medicare expenses and are also looking for less costly Medigap coverage, then you may want to consider Medigap Plan K. Although the coverage may be considered quite basic, Medicare Supplement Plan K 2020 may be suitable for your specific situation.
Medicare Supplement Plan K pays a percentage of the majority of the benefits it covers; this is with exception to Medicare Part A coinsurance & hospital costs for an additional year (after depleting what Original Medicare covers), after which the policy covers this benefit in full. Due to the fact that you are subject to paying higher out-of-pocket expenses, out of the 10 standardized Medigap policies, Medicare Supplement Plan K rates/premiums are much less costly.
Standardized Medigap refers to policies that are identified with the same letter type. These policies must provide the same basic benefits no matter what carrier is selling the coverage. For example, Insurance Carrier Z selling Medigap Plan G in Texas must have the same basic benefits as the same policy sold by Insurance Carrier Y in New Jersey. The key disparity between the policies sold by these different carriers is the cost of the premium. Some companies may offer extra benefits with their Medigap policies, however, basic benefits must be uniform across all companies.
Medicare Plan K Eligibility
Before getting into Medigap Plan K benefits, here are the general eligibility requirements:
You are at least 65 years of age and have been a US Citizen or permanent legal resident for at least five consecutive years
You are currently receiving retirement benefits
You are disabled and therefore receiving disability benefits
You have End-Stage Renal Disease
You have Lou Gehrig’s disease or ALS
What does Medicare Supplement Plan K Cover?
Covers 50% of the cost for the following benefits:
Deductible for Medicare Part A
Hospice care coinsurance or copayment for Medicare Part A
Coinsurance for skilled nursing facility care
Copayment or coinsurance for Medicare Part B
The first three pints of blood received on a yearly basis
Coinsurance hospital costs for Medicare Part A up to an extra 365 days after Medicare benefits have been depleted
What does it not cover?
Part B excess charges
Medicare Part B deductible
*For any covered service, there is a standard approved amount that Medicare will pay. There are doctors, however, that may charge more than the approved amount, and the difference of which, known as the excess charge, you would be responsible for paying.
How Does Medigap Plan K Work? This plan’s Medicare supplement insurance cost (premium) varies from one insurance company to another, but besides the premium, with Medigap Plan K coverage only paying for 50% of the majority of its benefits, you will be responsible for paying a portion of the expenses associated with the benefits mentioned above. With everyone having their own individual situation and lifestyle, your out-of-pocket projections are unique to you.
If you estimate that your out-of-pocket expenses will be low for the year, then Medicare Supplement Plan K coverage options may be suitable in meeting your needs. If however, you find that your expenses will be higher than what you would prefer to pay out-of-pocket, then the Medicare Supplement Plan K copay arrangement may not benefit you much at all.
*An important note to take into account is the out-of-pocket limit. In contrast to all other Medigap coverage, Medicare Supplement Insurance Plan K includes an out-of-pocket yearly limit of $6,220 for the year 2021 on all Medicare-covered services. As soon as your spending has reached this limit, the policy will pay 100% of the covered services for the rest of the year. Medigap Plan K and L Plan K is similar to Plan L with a bit less protection. Unlike Plan K; Plan L pays 100% of Original Medicare Part A hospital costs and coinsurance and does not cover the Part B deductible, Part B excess charges, or foreign travel emergency costs. Plan K pays for 50% of Medigap benefits related to Original Medicare (Parts A&B) copayments, coinsurance, and skilled nursing facility care. It does not cover the Part B deductible, Part B excess charges, or foreign travel emergency costs. Plan L, on the other hand, pays 75% of these benefits. Plan K pays 100% of enrollees’ Medicare-covered costs for the rest of the policy year. However, they have to meet the annual Medicare Part B deductible and the annual maximum out-of-pocket limit ($6,220 in 2021).