How does Medigap Plan K compare to Plan G for someone on a tight budget?
Answered by 17 licensed agents
Medigap Plan K differs from Medigap Plan G in the following ways: Plan K covers only 50% of coinsurance/copayment costs for benefits such as Part B cost share; blood; Part A hospice; skilled nursing; and Part A deductible. Plan K offers no coverage for costs such as Part B deductible; Part B excess charges; and foreign travel emergency. With an out of pocket limit of $7220 in 2025, careful consideration should be taken by an individual on a tight budget to ensure that the premium savings is worth the additional financial exposure. A standard High Deductible plan G or F may be a better alternative. For more information on your specific situation, please call me directly at 239.848.8893.
Medicare G is the most comprehensive and most expensive. Plan K is less expensive but has a higher max out of pocket. Ideal for someone in good health and able to pay out of pocket.
Since plan G has been the most popular plan for many years and some insurance firms don't even offer Plan K (I have never written up a K application!) I’d suggest that you ought to pay more attention to the health benefits of G, rather than the saving of money. You only have one life to live!
Medigap Plan K offers lower monthly premiums, but the beneficiary has more out-of-pocket spending. It is similar to a Medicare Advantage plan, except that most Medicare Advantage plans don't have a premium. Plan K only covers a percentage of the costs.
Medigap Plan G has higher monthly premiums, but the only out-of-pocket cost a beneficiary is responsible for is the Part B deductible.
To specifically answer this question and maintain compliance with Medicare guidelines, comparing plans should be discussed with a licensed agent with Medicare approved outlines and sales materials. Most people are enrolled in a Plan G or Plan N. Plan K is not offered by some companies. Plans with less market share tend to be higher in premium in comparison to the benefits.
For someone on a tight budget, Medigap Plan K is generally a better option than Plan G. Plan K offers lower premiums than Plan G, but with the tradeoff of requiring cost-sharing (paying a percentage of covered services). Plan G, while offering more comprehensive coverage, comes with higher premiums.
Medigap Plan K may cost half of Plan G but it has a 7K max out of pocket and cover half of what G does. If you’re healthy it’s a calculated risk. If you become not so healthy you may be stuck in a plan that will cost you out of pocket yearly vs having a G plan with about $250 out of pocket yearly.
I do not offer plan K as the HDG plan is a much better option than K as the max out of pocket on K in a bad heatlh year is double plus the K plan. In addition the K plan premium is much more than the HDG one. Overall the K plan makes no economic sense to me as the HDG gives you moe coverage for lower premiun
Plan G pays 100% of Medicare-allowed charges after you pay your Part B deductible. Plan K is less expensive, but it only covers Part B allowed charges at 50% until you hit the maximum out-of-pocket limit. For 2025 it is $7,060. After that it will pay 100%, just like a Plan G with a few exceptions.
Plan K also does not cover 15% excess charges that may be allowed. And it does not cover foreign travel emergency services. These are things to consider when comparing the two plans.
Medicare Plan K only pays for 50% of the costs until the out-of-pocket limit has been reached (for 2025 it is $7,220), then Plan K pays 100%. Plan G will pay 100% of the Medicare-covered charges after the yearly Part B deductible has been met.
In my county, a 65-year-old male non-smoker will pay about $94.00 less per month for Plan K than for Plan G, making it substantially cheaper than Plan G for an AARP United Healthcare Insurance Company Plan.
With a Plan G, in addition to the premium, you will have to pay the part B deductible ($257.00 in 2025) and all Part A and Part B approved charges are paud by the policy at 100%. With the Plan K, in addition to the premium, you will pay the Part B deductible and be responsible for 50% of the approved charges for Part B coinsurance, Blood benefit (firts 3 pints) Part A hospice care, Skilled nursing facility coinsurance, and Part A deduclible. In addition, on Plan K you may be charged excess charges.
If you have a tight budget, Medigap Plan K could be a suitable option since it typically charges a lower monthly premium than Plan G, but also has less comprehensive coverage. Plan K only covers about 50% of many key benefits like Part B coinsurance, skilled nursing facility care, and the Part A deductible. Therefore with Plan K, your fixed costs (monthly premium) would be lower when compared to Plan G, and may be a better option for your tight budget as long as you are relatively healthy and don't require frequent medical care.
With Plan K, you'll typically pay a lower monthly premium, which looks good upfront, but you'll be responsible for half of many medical bills until you hit a set yearly out-of-pocket limit. Plan G, on the other hand, comes with a higher monthly premium, but once you cover the small annual Part B deductible, it pretty much takes care of everything else, offering much more predictable costs throughout the year. So, if you're on a tight budget, it really boils down to whether you prefer a lower regular payment with the risk of higher medical bills if you get sick, or a higher regular payment for the peace of mind that most costs are covered after that initial deductible.
