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What Are Out-of-Pocket Costs for Medicare Supplement Plans K and L?

Healthcare Writer

Last updated June 17th, 2020

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

  • 2020’s out-of-pocket limit for Medicare Supplement Plan K: $5,880.
    • The 2019 out-of-pocket limit for Medicare Supplement Plan K was $5,560.
  • 2020’s out-of-pocket limit for Medicare Supplement Plan L: $2,940.
    • The 2019 out-of-pocket limit for Medicare Supplement Plan L was $2,780.

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 is 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% coinsurance. With Medicare Supplement Plan L, you’re responsible for 25% coinsurance.

The out-of-pocket limits for these plans change annually. Once you meet that limit, as well as your yearly Part B deductible, Plan K and Plan L both pay 100 percent of covered services for the rest of the calendar year. 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, which typically has lower premiums. It pays 100% of the Medicare Part B coinsurance but in most cases, requires a copayment of $20 for doctor visits and $50 for emergency room visits that don’t require inpatient admission. It won’t cover Part B costs until the Part B annual deductible is met, and it won’t cover Part B excess charges. 
  • 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. You can select either a Medicare Advantage plan or a Medigap plan, but not both. 
  • Costs for Original Medicare, and average premiums 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. But make sure you know your state’s rules for changing plans. Generally, you can only change your Medicare Advantage plan during the annual election periods, January 1 through March 31 or October 15 through December 7. Medicare Supplement plans can be changed anytime, but you’ll likely have to apply to the insurance company, go through underwriting, and get approval for the change.

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