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Q: What Are This Year’s Out-of-Pocket Costs for Medigap Plan K and Medigap Plan L?

Asked by Anonymous on November 20, 2018

The out-of-pocket limit for Medigap Plan K and Medigap Plan L subscribers changes every year. What will their out-of-pocket maximum be in 2019?

Hal Levy November 20, 2018

Medigap Plan K and Medigap Plan L are the two types of Medicare Supplement policies that charge you coinsurance (a fixed percentage of covered services).

  • 2019’s out-of-pocket limit for Medigap Plan K: $5,560.
    • The 2018 out-of-pocket limit for Medicare Supplement Plan K is $5,240.
  • 2019’s out-of-pocket limit for¬†Medigap Plan L: $2,780.
    • The 2018 out-of-pocket limit for Medicare Supplement Plan L is: $2,620.

How Does This Coinsurance Apply?

You don’t owe coinsurance on the full cost of medical services with Plan K or Plan L.

Only the portion of your out-of-pocket costs that are not covered by Medicare Part A and Part B is shared with your Medicare Supplement plan.

With Medicare Supplement Plan K, you’re responsible for 50 percent coinsurance. With Medicare Supplement Plan K, you’re responsible for 25 percent coinsurance.

The out-of-pocket limits for these plans change annually. Changes are based on inflation estimates from the Centers for Medicare and Medicaid Services (CMS). Your coinsurance percentage on these plans does not change.

Medicare Coverage Without Coinsurance

  • While other Medicare Supplement plans don’t charge coinsurance, they typically have more expensive monthly premiums.
    • If you’re considering Medicare Supplement Plan K or Plan L, you like to actively manage your expenses. You may also enjoy Medicare Supplement Plan N. Plan N has copayments the range from $20 to $50 per medical visit, but no coinsurance.
  • Medicare Advantage plans are private Medicare replacements with their own fee structures and doctor networks. These plans have an annual out-of-pocket limit of their own.
  • Costs for Original Medicare, and average costs for supplemental coverage, also change each year.

It’s free to check your local options for Medicare Supplement and Medicare Advantage, no matter what your health conditions are.

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