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Learn » Medicare Supplement » Medigap Plan K & Plan L – the Convenient Middle Ground of Medicare

Medigap Plan K & Plan L – the Convenient Middle Ground of Medicare

If you'd like basic Medicare Supplement protection for lower upfront costs, Plans K and L may be right for you.

June 3, 2019 - By Bud Scannavino - read

Medigap Plan K and Plan L are unique in the Medicare Supplement (Medigap) world. These two plans cost relatively little on a monthly basis, since you’ll also share the cost of coinsurance for your Plan K and L bills (50 percent for K and 25 percent for L) up to an annual out-of-pocket limit.

For example, if you had Plan K and received an outpatient bill for $100:

  • Original Medicare would pay $80, leaving $20 left to pay.
  • Medigap Plan K would then pay $10, and
  • You would pay $10.

Without a Medicare Supplement, you would pay the full $20 out-of-pocket charge, with no cap on the amount you might be charged during the year. With a different type of Medicare Supplement, you would pay a higher monthly premium but your plan would pay the full $20 charge.

Your cost-sharing ends once you reach that annual Plan K or L out-of-pocket limit. After you spend a certain amount, you don’t have to contribute to coinsurance for the rest of the year. Since most people don’t reach that out-of-pocket limit, monthly prices may be significantly lower than other Medigap plans, for all plan members.

Like all other Medicare Supplements, these plans step in to pay the deductibles and copayments that Original Medicare would otherwise charge to you. Let’s look at Medigap Plan K and Plan L, and compare them both.

Some Call Medicare Supplement Plans K and L “the Middle Ground of Medicare”

There are a variety of ways to get help with Medicare payments, ranging from zero-premium Advantage plans to very expensive Medicare Supplements. For many people, neither one of those extremes is a good fit for their health insurance needs. Plan K or Plan L could give you a reasonable compromise between price and benefits, a compromise that you can live with.

Don’t Shun A Lower-Priced Supplement

The monthly premiums for the most popular Medicare Supplements, Plans F and G, are among the highest for those of all Medicare Supplements. Perhaps that price is higher than you feel comfortable paying. If so, then discover what a lower-priced Plan K or L has to offer.

Plans K and L cost less than other Medigap plans on a monthly basis. This makes them similar to Medicare Advantage with its low monthly costs, but with different Medicare Supplement benefits like the ability to see any Medicare doctor.

The Benefits of a Medicare Supplement Plan K or L

  • You have reasonable copayments, which are similar to those of typical Medicare Advantage plans.
  • Your maximum out-of-pocket expense for Medicare-covered deductibles and copayments is limited. For 2019, it is $5,560 with Plan K. That compares favorably to the yearly maximum out-of-pocket costs of typical Medicare Advantage plans, which max out at $6,700.

Interested? Here Are Your Out-Of-Pocket Costs with Plan K and L

  • 50% or 25% of the $682 hospital deductible per benefit period (that’s $682 in 2019)
  • 50% or 25% of the cost of the first three pints of blood
  • 50% or 25% of your hospice care and 50% or 25% of your skilled nursing facility (SNF) copayments (already largely covered by Medicare Part A).
    • For example, SNF copayments in 2019 are $170.50 per day for days 21 through 100 that you spend in a rehab facility. So, you would pay half of that amount, $80.25 per day, for up to 80 days.
  • 50% or 25% of your Part B copayments
  • Plan K and L both cover 100% of your Part A coinsurance charges. Those come into play when you accumulate over 60 days of hospital stays in a single benefit period.
  • Foreign travel emergencies, the annual Part B deductible, Part B excess charges are not covered.

Once you reach your out-of-pocket limit on Plan K or L, they will cover all of these charges in full. These plans do not replace Original Medicare, which will also continue to pay its share of charges.

Medicare Supplement Plan L vs. Plan K

In practical terms, is the 75 percent coverage of Plan L worth paying for, beyond the 50 percent coverage of Plan K? It depends. Typically, the Plan L monthly premium approaches the price of a Plan N, depending on which insurance company you buy it from. In that case, it is often best to buy the Plan N instead of buying a Plan L.

Plan K has more members than Plan L in most states, but both are typically close in size to one another. But if you like Plan L and are most concerned about the maximum out-of-pocket limit, then know that Plan L caps your maximum yearly expense at half of what Plan K has.

Get Your Biggest Worry Solved First – Hospital Bills

It’s not doctor’s bills but hospital bills that worry many people. When you enter the hospital with Original Medicare, you have an immediate deductible of $1,364, out of your pocket. You could pay that deductible up to five times each calendar year (though five hospital visits in a single year would be rare). Without Medicare Supplement, you could pay an unlimited amount once your hospital benefits run out.

Rather than worry about paying that $1,364 deductible (in 2019) by yourself, know that Plan K would pay half of it for you, as many times as necessary. That means only $682 out of your pocket. Compare that to your hospital copayments under Medicare Advantage plans, which would typically be from $300 to $400 per day for the first four to seven days. Looking at it like that, Plans K and L look pretty good.

Get More Information on Plan K and L

If you’ve been frustrated trying to decide which Medicare insurance is the right fit, then Medicare Supplement Plans K or L might be a good compromise from among your options. You can enjoy a lower monthly cost, with room to choose a good (perhaps even the best) standalone RX plan available for medications in your area.

Medigap coverage is good from coast-to-coast, and so are we. Call or compare with HealthCare.com, and we’ll put you in touch with a qualified, trained and licensed agent who offers these plans in your state.

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