How does Medigap Plan K compare to Plan G for someone on a tight budget?
Answered by 15 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!
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.
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.
