What Are the Benefits of Plan K?
Plan K is unique. It covers:
- Medicare Part A coinsurance and hospital costs — up to an additional 365 days after Medicare benefits are exhausted.
- 50% of Part B copayment
- 50% of blood
- 50% of Part A hospice care copayment
- 50% of Part A deductible
- 50% of skilled nursing facility coinsurance
What Costs Are You Responsible for?
With Plan K, policyholders will be responsible for the Part B deductible ($203 in 2021), Part B excess charges, and foreign travel emergency care.
This policy will still cover preventative care services and give you an additional year in the hospital. But you split the cost-sharing with the insurance company on certain things, like the Part A deductible and Part B copay.
In short, you get fewer benefits for lower premiums.
It Includes a Cap on Your Spending
Plan K also includes an out-of-pocket maximum — $6,220 in 2021. So you wouldn’t spend more than this amount in any calendar year. If for some reason you do spend more than the max, the insurance policy will cover 100% of the remaining expenses after that. So if you have a year with many medical treatments, this cap can be really useful.
Plan K Eligibility and Enrollment
There are certain eligibility rules you should know when buying any Medigap plan:
- You must have Original Medicare A and B, and you can’t have Medigap and Medicare Advantage.
- A Medigap policy just covers one person. Your spouse will need to buy a seprate policy.
- Insurers aren’t legally required to sell Medigap plans to those under 65. If you’re under 65 and on Original Medicare, you may not be able to buy the plan you want.
If you’re interested in Plan K, you can first enroll during Medigap Initial Enrollment — a six-month period that begins when you turn 65 and enroll in Medicare Part B. If you don’t sign up during this time, you may not be able to get the plan you want or it might cost more.
How the Companies Charge You
Every Medigap policy has a monthly premium. The exact amount may vary by area, gender, and tobacco status. Insurers can set monthly premiums for their policies in three ways:
- Community rated — Everybody who buys the plan pays the same monthly amount no matter their age.
- Issue-age rated — Monthly premiums are based on the age when you first buy a plan. Younger buyers will have lower premiums, and the premiums don’t go up as you get older.
- Attained-age rated — Monthly premiums are based on your CURRENT age. So, your premium will increase as you get older.