Getting Care in Emergencies: What You Should Know
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Medicare Supplement Plan K
What is Medicare Supplement Plan K?
Medicare Supplement insurance: Plan K basic benefits
Medigap Plan K’s benefits pay 50% of several cost-sharing expenses in Original Medicare, which may include the following costs and benefits:
- Part A deductible
- Part A hospice care coinsurance or copayment
- Part B copayment or coinsurance
- First three pints of blood for a covered medical procedure
- Skilled nursing facility (SNF) care coinsurance
With Medigap Plan K, beneficiaries must pay both the Medicare Part B deductible and Part B excess charges in full; Plan K doesn’t cover these costs.
Medicare Part B excess charges are extra charges your doctor may bill you for outside of the Medicare-approved charge. Medicare has a “fee schedule” of approved amounts that doctors may charge for Medicare-covered services; however, doctors who do not accept assignments may charge up to 15% above these amounts.
Unlike most of the Medigap plan types, Medigap Plan K includes an out-of-pocket yearly spending limit of $5,880 in 2020 for Medicare-covered services. Once your out-of-pocket spending has reached the plan limit, Medigap Plan K pays 100% of covered services for the remainder of the calendar year.
Original Medicare does not come with a maximum spending limit, meaning there is no annual cap on your health-care expenses, no matter how high your medical costs may get. Plan K’s out-of-pocket limit may be helpful if you want protection in the event of a medical emergency. With Plan K there is a cap on your Medicare costs for a given year.
Beneficiaries who frequently require medical services and may have high out-of-pocket costs may also want to consider Plan K if they believe their medical costs could go above the plan’s yearly limit.
Plan K basic benefits include the Medicare Part A coinsurance hospital costs, covering up to an extra 365 days after Medicare benefits are exhausted. This is the only benefit that Plan K may pay in full.
The best time for beneficiaries to enroll in Medicare Supplement Plan is during their Medicare Supplement Open Enrollment Period, which is not the same for everyone.
This period begins on the first day of the first month that you are both age 65 or older and enrolled in Medicare Part B, and lasts for six months. During this time, private insurance carriers may not use medical underwriting to assess a beneficiary’s health condition.
This means that if you’re enrolled in Medicare Part A and Part B and live within a Medigap plan’s service area, you can enroll in that Medigap plan without fear of being denied coverage or charged higher premiums based on a pre-existing health condition (although waiting periods may apply).
*Medigap plans do not include prescription drug benefits; if you’re enrolled in Original Medicare and want coverage for your medications, you should enroll in a stand-alone Medicare Prescription Drug Plan.
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