Plan K pays 50% of most cost-sharing, then caps your annual out-of-pocket at a limit that is reset each year. After you hit the cap, the plan pays 100%. Best for beneficiaries comfortable with more month-to-month variability in exchange for lower premiums.
Best for
- Healthy beneficiaries who rarely use medical services
- Budget-focused shoppers comfortable with cost-sharing
Watch out for
Higher out-of-pocket exposure in heavy-use years.
What Plan K covers
- Part A coinsurance & 365 extra hospital daysCovered in full
- Part B coinsurance or copayment50% covered
- Blood (first 3 pints)50% covered
- Part A hospice coinsurance / copay50% covered
- Skilled nursing facility coinsurance50% covered
- Part A deductible50% covered
- Part B deductibleNot covered
- Part B excess chargesNot covered
- Foreign travel emergency (up to plan limits)Not covered
Compare to other Medigap plans
- Plan AThe minimum-coverage Medigap plan - basic benefits only.
- Plan BPlan A plus the Part A deductible.
- Plan CComprehensive coverage - closed to anyone newly eligible after Jan 1, 2020.
- Plan DPlan G minus Part B excess. Modest savings, modest reduction in benefit.
- Plan FThe 'everything' plan - closed to newly eligible after Jan 1, 2020.
- Plan GToday's most popular Medigap plan - comprehensive coverage minus only Part B deductible.
- Plan LLike Plan K but covers more - 75% of most cost-sharing.
- Plan MSplits the Part A deductible 50/50 between you and the plan.
- Plan NLower premium than Plan G in exchange for office and ER copays.
How Does Medigap Plan K Actually Work?
Plan K is built for a lower monthly premium. It does that by sharing costs with you instead of covering them all. Most benefits are paid at 50 percent until you hit a yearly limit.
That limit is the best feature of the plan, and many people miss it. Once your share of covered costs reaches it, Plan K pays covered services in full for the rest of the year. Medicare sets the limit, and it changes each year.
How a year on Plan K unfolds
- 01
You pay the Part B deductible
Plan K does not cover it. You pay this once each calendar year, before the plan shares other costs.
- 02
The plan pays half of most bills
Your share of the hospital deductible, doctor coinsurance, and nursing care runs at 50 percent.
- 03
Your share adds up toward the limit
Every dollar you pay on covered services counts toward the yearly out-of-pocket limit.
- 04
Coverage becomes complete
Once you reach the limit, Plan K pays covered services in full until January resets the count.
The short version
Plan K carries the lowest premiums of any Medigap letter. You trade that for real cost sharing during the year, protected by a yearly ceiling.
What Does Plan K Cover, and What Do You Share?
- Covered in full: Part A hospital coinsurance, plus 365 extra hospital days after Medicare benefits run out.
- Covered at 50 percent: the Part A hospital deductible for each benefit period.
- Covered at 50 percent: Part B coinsurance for doctor visits, labs, and outpatient care.
- Covered at 50 percent: skilled nursing coinsurance, hospice coinsurance, and the first three pints of blood.
- Not covered: the yearly Part B deductible, Part B excess charges, and foreign travel emergency care.
Two gaps to plan around
Plan K leaves out travel coverage, so emergency care abroad is on you. It also leaves out Part B excess charges, which California allows some providers to bill. Excess charges do not count toward your yearly limit, either.
Prescriptions are separate
No Medigap plan covers drugs. Plan K members add a stand-alone Part D plan. Part D now has its own yearly cap on out-of-pocket drug costs, and that cap changes each year.
Who Is Plan K Genuinely a Good Fit For?
Who this is for
Plan K can be a smart buy if:
- You are healthy and rarely use medical services.
- The monthly premium matters more to you than steady bills.
- You keep savings set aside for a heavy medical year.
- You want a hard ceiling on what a bad year can cost.
- You do not travel abroad, or you carry separate travel insurance.
Now the honest part. Plan K can cost you far more than Plan G in a year with a hospital stay. Half of the hospital deductible is real money, and so is half of every specialist bill.
How Does Plan K Compare to Plan L?
Plan L is the closest alternative. It uses the same design with a friendlier split. You pay a bit more each month and share less when care happens.
Plan K vs. Plan L at a glance
Plan K
The lowest premium in the Medigap lineup, with the most cost sharing.
- Monthly premium
- Lowest of the two
- Part A hospital coinsurance
- Covered in full
- Part A deductible
- Plan pays 50 percent
- Part B coinsurance
- Plan pays 50 percent
- Skilled nursing coinsurance
- Plan pays 50 percent
- Yearly out-of-pocket limit
- Higher, so it takes longer to reach
- Part B excess and travel
- Not covered
- Best for
- Healthy budget shoppers who rarely use care.
Plan L
The same structure with a larger share paid by the plan.
- Monthly premium
- Higher than Plan K
- Part A hospital coinsurance
- Covered in full
- Part A deductible
- Plan pays 75 percent
- Part B coinsurance
- Plan pays 75 percent
- Skilled nursing coinsurance
- Plan pays 75 percent
- Yearly out-of-pocket limit
- Lower, so full coverage arrives sooner
- Part B excess and travel
- Not covered
- Best for
- Middle ground between Plan K and Plan G.
Compare the two by the worst year, not the average year. Look at each plan's yearly limit and ask whether you could pay it. If the answer is yes for Plan K, the lower premium may be worth it.
How Do California's Birthday Rule and Trial Rights Work?
California gives Medigap members a yearly chance to change carriers with no health questions. It is called the birthday rule, and it is unusually generous.
- The window. It opens on your birthday each year and stays open 60 days.
- The limit. You may move to the same letter with another carrier, or to lesser benefits. Plan K sits low on the benefit ladder, so the rule rarely lets you move up from it.
- The timing. Ask for quotes about two months early. Some carriers want the application before the window closes.
- The overlap. Keep the current policy until the new one is issued, so no gap appears.
Trial rights are a different, federal protection. They apply to people who tried Medicare Advantage and want Original Medicare back. Both versions are guaranteed-issue rights, so no underwriting applies.
- You joined Medicare Advantage when you first turned 65. Leave within the first 12 months, and you may buy any Medigap plan sold in California.
- You dropped Medigap to try Medicare Advantage for the first time. Switch back within 12 months, and you may reclaim your old policy. If it is no longer sold, Plan K is on the list you may buy.
Plan the move before you need it
If Plan K was a budget decision, revisit it each year. We check every client's letter, rate, and health picture during their annual review, while options are still open.
What Does Underwriting Look Like Outside a Guaranteed-Issue Window?
The cleanest window is Medigap open enrollment. It runs six months from the month you turn 65 and have Part B. During it, carriers must accept you at their standard rate.
This matters more on Plan K than on most letters. People often choose K to save money, then want richer coverage after a health scare. By then, a carrier may require medical underwriting.
- Health questions about conditions treated in the past two to five years.
- A prescription history check, pulled electronically in minutes.
- Height and weight, measured against the carrier's build chart.
- Pending care, such as a scheduled surgery or a test awaiting results.
- A short phone interview at some carriers, to confirm your answers.
Choose K with open eyes
A move up from Plan K later is not guaranteed. Pick it because the tradeoff genuinely fits you, not because you plan to upgrade after something goes wrong. And never cancel current coverage before a new policy is issued.
How Do You Price Plan K in Orange County?
Fewer carriers sell Plan K than sell G or N, so quotes are thin and the spread can be wide. Benefits are identical by federal law, which makes price and service the whole comparison.
- Which carriers actually offer Plan K for your age and ZIP code.
- How Plan K's premium compares to Plan L and Plan N for the same person.
- Rate increase history, since a thin market can mean sharper increases.
- Household and payment discounts, which several carriers offer.
Run the numbers with a licensed agent
Harmony SoCal Insurance Services is an independent multi-carrier agency at 2135 N Pami Circle, Orange, CA 92867. Call (714) 922-0043 or request a review. California license #0718082. Meet in person, by video, or by phone, in English and Spanish, with Korean, Mandarin, and Vietnamese available. Want the full lineup? See the Medigap overview.