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Understanding Medigap Plan K

Understanding Medigap Plan K

Understanding Medigap Plan K can be extremely helpful to you if you are enrolled in Medicare Part A and Part B and you are paying a great deal of out-of-pocket expenses each year on your health care services in the form of copayments, coinsurance, and / or deductibles. If you currently have a plan such as Plan J and have questions, we can help you find the answers you are looking for.

Although the Medicare program is designed to help those who are age 65 and over (as well as certain other individuals who are under age 65 and disabled) to pay for hospitalization and other health-related services, many people are surprised at the number of items that are not covered – which can be especially difficult for those who are living on a budget. The good news is that there is a way to help you in curbing these expenses. This can be done by obtaining a Medicare Supplement insurance policy such as Medigap Plan N.

What is Covered Under Medicare Supplement Insurance Plan K?

While there are many different options to choose from concerning Medicare Supplement insurance coverage, some plans may be better than others, depending on your specific needs. For those who may be seeking help with certain expenses under Medicare Parts A and B, while at the same time not wanting to pay out a great deal in premium, then Medicare Supplement Plan K could be a good option.

This is because Medigap Plan K pays a certain percentage of many of the covered benefits – other than the Medicare Part A coinsurance and hospital costs for the additional 365 days. (Plan K keeps this benefit at 100% because the out-of-pocket expenses here typically tend to be more with this plan).

The benefits that are covered under Medicare Supplement Plan K include:

  • Medicare Part A coinsurance and hospital costs – up to an additional 365 days after Medicare benefits are used (100%)
  • Medicare Part B coinsurance or copayment (50%)
  • First three pints of blood per year (50%)
  • Medicare Part A hospice care coinsurance or copayment (50%)
  • Skilled nursing facility care coinsurance (50%)
  • Medicare Part A deductible (50%)

Why Consider Medicare Supplement Plan K Versus Other Medigap Plans?

There are several reasons to consider the purchase of a Medicare Supplement Plan K. One of the primary advantages of this particular plan is the fact that it provides basic and / or partial coverage for many of the out-of-pocket charges that you may be faced with throughout the year as an Original Medicare enrollee – yet the premium is likely to be lower with this plan as compared to most of the other Medigap plans that are available.

Also, Medicare Supplement Plan K is one of just two Medigap insurance plans that has an annual out-of-pocket limit. In 2016, that amount is $4,960. What this means is that, once your out-of-pocket expenses have reached this amount – which is inclusive of the yearly Medicare Part B deductible – then the Medicare Supplement Plan K will cover 100 percent of your Medicare-covered expenses for the remainder of the year.

How Does Medicare and Its Expenses Work?

The Medicare program – initially designed as just Part A and Part B – now consists of four primary components. These include:

  • Medicare Part A – Hospitalization Coverage: Part A of Medicare covers inpatient hospitalization care. Also, Part A of Medicare will also cover some forms of home health care services that follow an inpatient hospital stay, as well as some limited skilled nursing facility care, and some hospice care services.
  • Medicare Part B – Doctor / Medical Services: Part B of Medicare provides coverage for doctor and medical services. This can help in covering items such as outpatient hospital care, as well as doctor visits and ER department care. Part B can also provide coverage for durable medical equipment that may be required for you to use in your home and is ordered by a doctor. In addition, Medicare Part B can also offer coverage for certain preventive care such as flu and pneumonia vaccinations. Medicare Part A and Part B are often referred to as “Original Medicare.”
  • Medicare Part C – Medicare Advantage: Medicare Advantage is another name for Medicare Part C. This is an alternate method of receiving your Medicare Part A and Part B benefits. Medicare Advantage plans are sold through private insurance companies – and these plans must provide at least the same coverage that is offered through Medicare Parts A and B. However, additional benefits may also be offered, such as vision, dental, and / or wellness benefits. Also, there are many Medicare Advantage plans that include prescription drug coverage as well.
  • Medicare Part D – Prescription Drug Coverage: Prescription drug coverage offered through Medicare Part D helps to cover the high cost of prescription medications. This coverage is purchased separately by those who are enrolled in Medicare Part A and Part B, as it is often already included in Medicare Advantage plans.

While Medicare Parts A and B do cover a wide range of health care services, they can also come with a lot of out-of-pocket costs to enrollees. For instance, each part of Medicare has a deductible that must first be met before the coverage will pay. The deductibles and copayments / coinsurance for Medicare Parts A and B for 2016 include the following:

Medicare Part A hospital inpatient deductible and coinsurance:   •   $1,288 deductible for each benefit period

  • Days 1 – 60: $0 coinsurance for each benefit period
  • Days 61 – 90: $322 coinsurance per day of each benefit period
  • Days 91 and beyond: $644 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs

Medicare Part B deductible and coinsurance:

  • Deductible of $166
  • After the deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor’s services (including most doctor’s services while you are a hospital inpatient), outpatient therapy, and durable medical equipment.

What is Medicare Supplement (Medigap) Insurance Coverage?

There can be a plethora of out-of-pocket costs when it comes to Original Medicare. However, enrollees can oftentimes reduce – or in some cases, even eliminate – these costs by purchasing a Medicare Supplement insurance policy.

Medicare Supplement coverage is a type of insurance that is designed for filling in the “gaps” that are left by Medicare Parts A and B. There are many different plans to choose from. However, in most cases, these plans can cover anything from the most basic of expenses to a comprehensive list of services – depending on your needs.

How Does Medicare Supplement Insurance Work?

There are currently ten different Medicare Supplement insurance plans to choose from. Each plan is named after a letter of the alphabet, beginning with Medigap Plan A, which offers the most basic set of coverage and Medigap Plan F having the most comprehensive. Most of the other Medicare Supplement plans are required to offer at least the core set of benefits that are provided by Medicare Supplement Plan A, which include:

  • Medicare Part A coinsurance for hospitalization costs – up to an additional 365 days after Medicare benefits are used up;
  • Medicare Part B copayment or coinsurance coverage;
  • First three pints of blood per year;
  • Medicare Part A hospice care coinsurance or copayment.

It is important to note that all of the private insurance companies that offer Medicare Supplement insurance coverage are required to provide identical benefits for each Medigap plan of the same corresponding letter. Therefore, all Medicare Supplement Plan K’s will be the same, regardless of where it is purchased from.

The amount of the premium for these plans, however, can differ – in some cases, quite a bit, even for the same benefits. For that reason, it will be important to shop carefully and to compare plans from several different Medicare Supplement insurance carriers before making a purchase.

What to Consider When Choosing a Medicare Supplement Insurance Policy

When choosing a Medicare Supplement insurance plan, it will be important to keep several criteria in mind. These can help you in determining which plan may be best for you and your particular situation.

For example, you should consider what your specific health care needs typically are throughout the year – as well as the health care services that are the most important to you. If you are married, you should also consider these same factors for your spouse.

You should also consider the amount of Medicare Supplement insurance premium that you may comfortably be able to pay – especially as it correlates to the amount of out-of-pocket expenses that you may have to pay (or that you could save) due to Medicare Part A and B deductibles, coinsurance, and copayments.

Who is Eligible to Purchase Medicare Supplement Insurance Coverage?

Before moving forward with the purchase of Medigap Plan K – or any Medicare Supplement insurance plan – you should also consider whether you are eligible to buy a plan. This is because, even if you are age 65 or over, it does not automatically mean that you qualify to purchase Medigap insurance.

To be eligible, you must be age 65 or older, and you must also be enrolled in Original Medicare (Medicare Part A and B) – not Medicare Advantage. In fact, if you are enrolled in Medicare Advantage, you will not be eligible to purchase a Medigap insurance policy unless you convert back over into Original Medicare.

When is the Best Time to Buy a Medicare Supplement Insurance Policy?

You will also need to be aware of when you should purchase your Medigap insurance. The very best time to do so will be during your open enrollment period. This is the six-month period during which you turn age 65, and you are also enrolled in Medicare Part B coverage. The reason for this is because, during your open enrollment time period, even if you have an adverse health condition, you cannot be turned down for Medigap coverage, nor can you be charged more for your plan.

If, however, you wait too long and your open enrollment period expires, then you run the risk of either being charged more for your plan – or even being denied for coverage altogether, if you are not in good health.

Where Can You Get the Best Premiums on Medicare Supplement Insurance Plan K?

When shopping for the very best premium quotes on Medigap Plan K, it is always a good idea to work with a company or an agency that has access to more than just one single Medicare Supplement insurance plan carrier. That way, you will be able to compare, in an unbiased manner, multiple insurers’ plans, and from there you can determine which one will be the best for you.

If you are ready to proceed, we can help. We work with many of the top Medigap insurers in the marketplace today, and we can assist you with obtaining all of the important details that you will require for making a purchase decision. We can do so for you quickly and easily, and without the need to meet in person with an insurance agent. When you are ready to move forward, fill out the form on this page to get your first set of quotes.

We understand that when it comes to choosing a Medicare Supplement insurance plan, there are a lot of different variables to work with – so it can be somewhat confusing. But the good news is that we can walk you through all of the information and point you in the right direction towards the plan that will suit your needs the best. So, contact us today – we’re here to help.

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