Summary

Medigap Plan K is a Medicare Supplement Insurance (Medigap) option designed to help people with Original Medicare (Part A and Part B) pay some of the out-of-pocket costs that Medicare doesn’t fully cover. It often comes with lower monthly premiums than many other Medigap plans, but that trade-off is important: Plan K typically pays only 50% of many covered cost-sharing amounts. One standout feature, though, is that Plan K includes an annual out-of-pocket limit—meaning once you’ve spent up to that limit on covered costs in a given year, the plan pays 100% of its covered services for the rest of the year.

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🩺 What Medigap Plan K Is

Medigap Plan K is one of the standardized Medicare Supplement Insurance plans sold by private insurance companies to people enrolled in Original Medicare. “Standardized” means the core benefits are set by plan type (like Plan K), so a Plan K from one company must cover the same basic items as Plan K from another company—though prices and optional perks can differ. Plan K is often considered a budget-friendlier Medigap choice because it doesn’t cover as much as more comprehensive plans. Instead of paying most remaining costs after Medicare pays its share, Plan K generally splits many covered cost-sharing expenses with you, commonly paying 50% while you pay the other 50%. That structure can keep premiums lower, but it also means you’ll want to be comfortable with potentially higher costs when you use care.

Takeaways:

• Plan K helps with certain Part A and Part B out-of-pocket costs, but it’s not “full coverage.”
• Standardized benefits mean Plan K coverage is consistent across insurers (pricing can still vary).
• It may appeal to people who want lower premiums and can handle more cost-sharing.

Key Terms

• Medigap (Medicare Supplement Insurance): Private insurance that helps pay some costs Original Medicare doesn’t cover, like coinsurance, copays, and certain deductibles.
• Original Medicare: Medicare Part A (hospital insurance) and Part B (medical insurance).
• Standardized plan: A Medigap plan type with benefits defined by law, so the same plan letter has the same core coverage across companies.

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⚙️ How Plan K Works

If you have Medicare Part A and Part B, you can purchase a Medigap plan to help reduce the “gaps” in what Medicare pays—things like deductibles, coinsurance, and copayments. Plan K is different from many other Medigap options because it generally pays only 50% of the cost for most covered services it helps with. For example, if you owe a Part B coinsurance amount and the bill is $100, Plan K would typically pay $50 and you would pay the remaining $50. That cost-sharing approach is the main reason Plan K premiums are often lower than plans that cover a larger percentage of your costs. The other big feature is that Plan K includes an annual out-of-pocket limit for covered services; once you hit that limit in a year, Plan K pays 100% of its covered cost-sharing for the rest of the year. In 2026, that out-of-pocket limit is $8,000.

Takeaways:

• Plan K commonly pays 50% of many covered cost-sharing amounts; you pay the other 50%.
• It includes an annual out-of-pocket limit for covered services (2026: $8,000).
• Lower premiums can come with higher costs when you actually use care.

Key Terms

• Coinsurance: A percentage of costs you pay for a covered service after Medicare pays its share.
• Copayment (copay): A set dollar amount you pay for certain services.
• Out-of-pocket limit: A yearly cap on what you pay for covered cost-sharing; once reached, the plan pays more of covered costs for the rest of the year.

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✅ What Medigap Plan K Covers

Plan K covers several common Medicare cost-sharing categories, usually at 50% for the items listed below. It can help with hospital-related costs under Part A (including coinsurance and extended hospital coverage after Medicare benefits are used up), and it can also help with several Part B and post-hospital costs like coinsurance/copays and skilled nursing facility coinsurance. Plan K also helps with the first three pints of blood used in a transfusion, which is a standard Medigap benefit category. Importantly, Plan K includes that annual out-of-pocket limit in 2026 of $8,000—once you’ve spent up to that amount on covered cost-sharing in the year, Plan K pays 100% of its covered services for the remainder of the year. This combination—partial coverage plus an out-of-pocket ceiling—can be attractive for people who want some protection against very high cost-sharing without paying the premiums of more comprehensive plans.

Takeaways:

• Plan K helps with a mix of Part A and Part B cost-sharing categories.
• Many covered benefits are paid at 50%, not 100%.
• The out-of-pocket limit can provide a “worst-case” cost boundary for covered services.

Key Terms

• Part A deductible: The amount you may owe before Medicare Part A begins paying for covered hospital services in a benefit period.
• Skilled nursing facility coinsurance: The daily coinsurance amount you may owe for certain covered skilled nursing facility stays.
• Hospice care coinsurance/copayment: Cost-sharing you may owe for certain hospice-related services under Medicare.

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🚫 What Plan K Doesn’t Cover

Even though Plan K can reduce some of the most common gaps in Original Medicare, it doesn’t include every benefit that other Medigap plans may offer. Two notable exclusions are Medicare Part B excess charges (which can apply if a provider is allowed to charge more than Medicare’s approved amount and does so) and emergency care during travel outside the United States. Beyond Plan K specifically, it’s also important to remember what Medigap plans generally do not cover for new Medicare members: the Part B deductible (for those newly eligible since 2020), prescription drugs (those are typically handled through Medicare Part D), and routine long-term care such as non-skilled nursing home care. Medigap also usually doesn’t cover routine dental, vision, or private-duty nursing. Knowing these gaps upfront can help you avoid unpleasant surprises and plan for other coverage—like Part D for prescriptions or separate dental/vision policies if you want those benefits.

Takeaways:

• Plan K doesn’t cover Part B excess charges or foreign travel emergency care.
• Medigap plans generally don’t include prescription drug coverage (that’s Part D).
• Routine dental, vision, and long-term non-skilled care typically aren’t covered by Medigap.

Key Terms

• Part B excess charges: Extra charges above Medicare’s approved amount that certain providers may bill in some situations.
• Medicare Part D: Optional Medicare coverage for outpatient prescription drugs through private plans.
• Long-term care: Ongoing assistance with daily living (often non-skilled), such as custodial care in a nursing home.

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💵 How Much Plan K Costs

Plan K premiums are often lower than many other Medigap plan types because the plan covers less of your cost-sharing. Even so, the price you pay can vary a lot based on factors like where you live, your age, and whether you use tobacco. Medigap is regulated at the federal level for standardized benefits, but private insurance companies set their own premiums. In one example market (Atlanta), premiums for a 65-year-old female nonsmoker can start around $66 per month before discounts—but your rate could be higher or lower depending on your area and the company you choose. Since Plan K benefits are standardized, the cheapest Plan K policy and a more expensive Plan K policy provide the same core Medigap coverage; higher-priced options may come with non-insurance extras, but the Plan K medical benefits themselves don’t change. That’s why comparing prices from multiple insurers can be especially valuable when shopping for Plan K.

Takeaways:

• Plan K premiums are often lower because the plan covers less of your cost-sharing.
• Pricing can vary by company, age, location, and tobacco use.
• Because benefits are standardized, comparing cost can matter more than brand name.

Key Terms

• Premium: The amount you pay (often monthly) to keep your insurance policy active.
• Standardized coverage: Core Medigap benefits that remain the same for the same plan letter, regardless of insurer.
• Discounts: Price reductions some insurers may offer (availability and rules vary by company and state).

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🗓️ When to Enroll

Your best window to buy a Medigap plan—including Plan K—is typically during your Medigap open enrollment period. This six-month period begins when you’re 65 or older and enrolled in Medicare Part B. During this time, you generally get the best access and pricing because insurers usually can’t use your health or medical history to set your premium or deny coverage. If you wait until after open enrollment ends, you may face higher prices or you may be denied coverage based on your health status or medical history, depending on your state and circumstances. There are also situations where your timing can shift—such as if you continue working after 65 and stay covered by certain employer group health plans—so your effective Medigap enrollment window may start when you end active employment or lose that coverage. Some states also offer Medigap opportunities to people under 65 who qualify for Medicare due to disability, but the rules can vary, so local guidance can be helpful.

Takeaways:

• The six-month Medigap open enrollment period starts when you’re 65+ and enrolled in Part B.
• Enrolling during open enrollment often means easier approval and better pricing.
• After that window, underwriting or higher costs may apply depending on your situation and state rules.

Key Terms

• Medigap open enrollment period: A one-time six-month window when you can typically buy Medigap without health-based pricing or denials.
• Underwriting: An insurer’s process of evaluating health history to decide eligibility and pricing (often applies outside open enrollment).
• SHIP: State Health Insurance Assistance Program, a free resource that can help explain Medicare and Medigap options.

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Conclusion

Medigap Plan K can be a good fit if you want Medigap protection with a relatively lower premium and you’re comfortable sharing more of the cost when you receive care. Its defining features are the 50% cost-sharing on many covered benefits and the annual out-of-pocket limit (in 2026, $8,000) that can help cap your spending on covered services for the year. To get the smoothest shopping experience and potentially the best pricing, it often helps to enroll during your Medigap open enrollment period and compare multiple insurers since Plan K benefits are standardized. If you need help navigating your options, resources like your State Health Insurance Assistance Program (SHIP) and Medicare.gov can provide guidance tailored to your situation.