Becoming policyholders in the National Health Insurance Program comes with the option of purchasing a Medicare Plan K policy, a Medigap Supplemental Insurance. If you have Part A and Part B plans, you are eligible to enroll in Medigap Plan K during its enrollment period, which starts the first month you enrolled in Part B. Only private insurance companies offer Medigap policies that make the market competitive with different costs for the same coverages. Depending on the state you live the premiums may vary and increase. We will explain the policy and what it covers in 2022 and help you understand how Medigap plan K works.
What is Medigap Plan K
To understand how Medicare Plan K works, let us briefly discuss the National Health Insurance Program. Providing the most protection against the costs of healthcare services is the insurance program benefit package. Beneficiaries may have to pay additional costs, such as deductibles, co-payments, coinsurance, and the entire cost of services not covered by the program. For example, according to the 2022 Medicare and You Handbook, approximately 17 percent of beneficiaries purchased Medigap private supplemental insurance in 2008.
Medicare Plan K is an insurance policy sold by private insurance companies to cover those additional costs. It is a Medicare cost-sharing coverage that does not pay for any medical treatments not covered by the health insurance program. It may extend your coverage for services, such as hospital stays over the limit of the program’s benefit. Private insurance companies finance Medigap using payments collected from the beneficiaries.
Medigap Plan K Coverage Overview
In 2022, Medicare plan K covers 100 percent of medical services for the remaining year after you meet the out-of-pocket limit and Part B deductible of $233. The out-of-pocket limit is $6,620 for Medigap plan K. It does not cover Part B deductible, excessive charges, or international travel for emergencies. What the policy covers include the following:
- Medicare-Part A Coinsurance and Hospital Costs: 100 percent coverage, with up to 365 additional days after using your Medicare benefits.
- Medicare-Part A Hospice Care Coinsurance or Co-payment: 50 percent.
- Medicare-Part A Deductible: 50 percent.
- Medicare-Part B Coinsurance or Co-payment: 50 percent.
- Skilled Nursing Facility Care Coinsurance: 50 percent.
- First Three Pints of Blood: 50 percent.
Critical Facts about Medicare Plan K
- Must follow Federal and State Laws to protect policyholders.
- Must be enrolled in Part A Hospital Insurance and Part B Medical Insurance.
- You must pay a monthly premium for Plan K plus the Part B monthly premium.
- There may be two separate premium payments when you buy plan K and a different Medicare drug plan.
- Married couples must purchase separate coverage.
- You can only have drug coverage in one plan, Medigap or Medicare, not both.
- Depending on your state, you can purchase the Medigap Medicare-Select policy that allows the use of hospitals and physicians within its network. It covers full benefits coverage, excluding emergencies. Policyholders can change the plan to Medigap within one year after purchasing Medicare-Select.
Who is Eligible to Purchase the Medigap Plan K Policy?
If you are 65 or older and have both Part A and Part B coverages, you can buy the Medicare plan K policy. The enrollment period is the six-month period that starts the month you turn 65 and are a Part A and Part B policy owner. Individuals under 65, including disabled young people and those with End-Stage Renal Disease, may not be able to purchase Plan K, or they may have to pay a higher premium.
Types of Health Coverage Plan K Don’t Share Costs.
- Medicare-Drug Plans
- Medicare Advantage Plans
- Group Health Insurance Provided by Employers
- Union Group Health Insurance
- Medicaid
- Tricare
What are Part A and Part B Coverages
Part A is a hospital insurance plan covering hospital inpatient care, nursing center care, hospice care, and home health care. Plan B is medical insurance covering services provided by healthcare providers and physicians. Services include home health care, outpatient care, medical equipment, and preventive care, such as annual wellness visits and vaccines.
Lowering medical and hospital costs for Part A and Part B services is one benefit of Medicare plan K for policyholders. It covers 50 percent of the first three pints of blood, Part B coinsurance or co-payment, Part A deductible, nursing care coinsurance, and Part A hospice care coinsurance or co-payment. Of your Part A coinsurance and hospital costs, the plan will cover 100 percent.
If you have Medicare Advantage, it is illegal for someone to sell you a Medigap supplemental insurance policy unless you are switching back to Original Medicare. The plan covers Parts A, B, and D (drug coverage) all in one policy, which may offer vision, dental, and hearing. It differs from Original Medicare, which only covers its share of approved services of Parts A and B.
If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.
