Medigap Plan K

Medigap Plan K is a Medicare supplement that offers partial coverage for a select group of services that are not fully covered by standard Medicare plans.  As compared with other Medigap plans, Medigap Plan K offers lower premiums but higher deductibles.  If you’re looking for a Medicare supplement, the information below should help you determine whether or not Medigap Plan K is right for you.

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Coverage Provided by Medigap Plan K

The only thing that Medigap Plan K covers entirely is Medicare Part A coinsurance and coverage for hospital stays up to 365 days after standard Medicare benefits are used up.  In addition, Medigap Plan K covers 50% of some additional healthcare services, but does not offer any other full coverage as other Medigap plans do.  Medigap Plan K covers 50% of the following healthcare services:

  • Coinsurance and copayments not covered by Medicare Part B
  • Three pints of drawn blood
  • Coinsurance or copayments for hospice care not covered by Medicare Part A
  • Coinsurance for time spent in a skilled nursing care facility
  • Medicare Part A deductible

Medigap Plan K does not cover any copays or deductibles related to Medicare Part B, nor does it cover vision screenings, prescription drugs or hearing tests.  It also does not cover any travel health expenses that are covered by a select few Medigap plans.  Of all ten Medigap plans available, Medigap Plan K has the highest out-of-pocket requirement, which is currently set at $4800.  Once this limit is met and the policyholder’s yearly Medicare Part B deductible is paid in full, Medigap will pay 100% of the fees for services listed above for the rest of the calendar year.  It should be noted that most other Medigap plans have no out-of-pocket requirement; Medigap Plan L is the only other Medigap plan that has an out-of-pocket requirement before its coverage begins.

Who is Eligible for Medigap Plan K?

Medigap Plan K is available to anyone over the age of 65 who already has Medicare Part A and B policies, except for those living in Massachusetts, Minnesota and Wisconsin, as those states offer only very specific Medicare supplement plans.  Seniors should understand that they will not be covered for Medigap Plan K simply because their spouse has such a policy.  Instead, every senior who wishes to enroll in a Medigap plan, whether it is Plan K or otherwise, must register independently.

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All applicants for Medigap Plan K have guaranteed issue rights.  This means that any licensed insurance company which sells Medigap Plan K policies must approve the applicant’s application, even if a pre-existing health condition is present.  Despite the guaranteed issue requirement, it must be understood that Medigap Plan K policies cannot be issued to anyone holding a Medicare Advantage policy.  For this reason, Medicare Advantage policyholders must relinquish their existing policy before any Medigap Plan K policy can take effect.

When to Enroll for Medigap Plan K

Enrollment for a Medigap Plan K policy can be done as early as the first day of the month in which the applicant’s 65th birthday falls.  Registration will remain open for 6 months, and applications can be submitted at any time during this period.  Once this personal registration period passes, seniors can apply for Medicare Plan K in the general open enrollment period which falls each year between October 15 and December 7.  During this time seniors can also cancel their Medigap Plan K or change to a different Medigap plan.

How Much Does Medicare Plan K Cost?

Because Medigap Plan K demands higher out-of-pocket payments and provides only 50% coverage for most services, its costs are significantly lower than those of most other Medigap Plans.  For this reason, Medigap Plan K is suited towards those who are on a limited budget or healthy seniors who don’t expect to use the plan very much and aren’t worried about the potentially high out-of-pocket costs.  The median Medigap Plan K premium is around $950, though some younger applicants may be lucky enough to find premiums for under $500.  The highest premium for a Medigap Plan K policy is slightly more than $2000.

When comparing different Medigap Plan K options, it is critical to remember that the pricing of these plans is dependent on a range of factors including the applicant’s age, health history and location. Likewise, different insurance agents within the same geographic area may have different prices for the same Medigap Plan K, so it is wise to shop around before making a commitment.

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