Medicare Supplement Plan K is 1 of 10 different Medigap plans. It’s also 1 of 2 Medigap plans that has a yearly out-of-pocket limit.

In most U.S. states, private companies offer Medigap plans, also called Medical supplement plans, to help pay for some of the healthcare costs that Original Medicare (Part A and Part B) doesn’t cover.

Medigap plans are standardized across most states, meaning the same plan will offer the same coverage no matter where you live. But if you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies are standardized in a different way, so they have different names.

To qualify for any Medigap plan, you must be enrolled in Original Medicare.

Plan K includes Part A (hospital insurance) and Part B (outpatient medical insurance) costs, as well as some extras.

Here’s a breakdown of the costs that Medigap Plan K will cover:

  • Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted: 100%
  • Part A deductible: 50%
  • Part A hospice care coinsurance or copayment: 50%
  • blood (first 3 pints): 50%
  • skilled nursing facility care coinsurance: 50%
  • Part B coinsurance or copayments: 50%
  • Part B deductible: not covered
  • Part B excess charges: not covered
  • foreign travel exchange: not covered
  • out-of-pocket limit: $7,060 in 2024

When you have Original Medicare and buy Medicare Supplement Plan K from a private company, your Medigap policy will pay a portion of the Medicare-approved amount of covered healthcare costs after Medicare pays its share.

Medigap policies cover only one person. If your spouse qualifies for and wants a Medigap policy, you must buy separate policies.

One feature that distinguishes Medicare Supplement Plan K from most other Medigap options is the yearly out-of-pocket limit.

With Original Medicare, there is no cap on your annual out-of-pocket costs. Purchasing a Medicare Supplement Plan K limits the amount of money you will spend on healthcare during the course of a year.

This is often important for people who:

  • have high costs for ongoing medical care, often due to a chronic health condition
  • want to avoid the financial effects of a very expensive, unexpected medical emergency

How does the yearly out-of-pocket limit work?

Once you have met your yearly Part B deductible and your Medigap out-of-pocket yearly limit, your Medigap plan pays for 100% of all covered services for the rest of the year.

This means you should have no other out-of-pocket medical costs for the year as long as the services are covered by Medicare.

The other Medigap plan that includes a yearly out-of-pocket limit is Medicare Supplement Plan L. Here are the out-of-pocket limit amounts for both plans in 2024:

  • Medicare Supplement Plan K: $7,060
  • Medicare Supplement Plan L: $3,530

As previously mentioned, Plan K does not cover the Part B deductible, Part B excess charges, or foreign travel healthcare services.

Medigap policies also typically do not cover vision, dental, or hearing services. If you want this type of coverage, consider a Medicare Advantage (Part C) plan instead. (It’s important to note that you cannot have Part C and Medigap at the same time.)

Additionally, Medicare supplement plans do not cover outpatient retail prescription medications.

For outpatient prescription drug coverage, you’ll need a separate Medicare Part D plan or a Medicare Advantage plan with this coverage included.

Medicare Supplement Plan K coverage is 1 of 10 different Medigap plans to pay for some of the healthcare costs left over from Original Medicare coverage.

Along with Medicare Supplement Plan L, it is 1 of 2 Medigap plans that include a cap on the amount you can spend on Medicare-approved treatments.

Medicare Supplement Plan K does not include coverage for:

  • prescription drugs
  • dental
  • vision
  • hearing