Medicare Plan K 2026 Coverage, Costs, and Enrollment

What Is Medicare Supplement Plan K?

Medicare Supplement Plan K, also known as Medigap Plan K, is one of the ten standardized Medigap policies designed to help fill the “gaps” not paid by Original Medicare (Parts A and B). Offered by private insurers, Plan K assists with paying a portion of certain out-of-pocket costs-like coinsurance, copayments, and deductibles-left over after Original Medicare pays its share. Distinctly, Plan K only covers 50% of many eligible expenses, setting it apart from most other Medigap plans. However, its defining benefit is an annual out-of-pocket maximum, which sets a hard cap on what you pay each year for covered services, giving beneficiaries greater financial security.

For those interested in learning more about the structure and purpose of Medicare Supplement policies, our detailed guide on Medicare Supplement Plans lays out comprehensive options and comparisons.

What Does Plan K Cover?

Plan K provides coverage for a range of Medicare out-of-pocket expenses. Unlike most Medigap options, coverage is partial but ultimately stops your total exposure at the plan’s out-of-pocket limit each year. Here is a detailed breakdown:

• 100% Coverage:
  • Medicare Part A coinsurance and hospital costs-after Original Medicare benefits are exhausted, Plan K pays for up to 365 additional days of hospital care.
• 50% Coverage:
  • Part A deductible (hospital insurance deductible)
  • Part A hospice care coinsurance or copayments
  • Medicare Part B coinsurance or copayments
  • Skilled nursing facility coinsurance
  • First three pints of blood needed for a transfusion

Once you reach the Plan K out-of-pocket limit for 2026 ($8,000) and have paid your Part B deductible, the plan covers 100% of all additional approved costs for the remainder of the year. This annual limit is a crucial protection for those wanting to avoid unlimited medical expenses due to unforeseen health events.

Service	Percentage Covered by Plan K
Part A hospital coinsurance & up to 365 days after Medicare benefits	100%
Part B coinsurance/copayments	50%
First 3 pints of blood	50%
Part A hospice coinsurance/copayments	50%
Skilled nursing facility coinsurance	50%
Part A deductible	50%
Part B deductible	Not covered
Part B excess charges	Not covered
Foreign travel emergency	Not covered
Prescription drugs	Not covered by Plan K (available through separate Part D plan)

After Out-of-Pocket Maximum

• Once you spend $8,000 out-of-pocket on covered costs (excluding Part B premium), Plan K covers 100% of approved services for the remainder of the calendar year.
• Part B deductible in 2026 is $283; this amount is not covered by the plan and must be paid before Plan K coverage begins for Part B services.

What Isn’t Covered by Plan K?

Despite its powerful financial protection through a capped out-of-pocket limit, Plan K has notable exclusions. Understanding these limits is essential when evaluating if this plan is right for you:

• Medicare Part B deductible: You are responsible for the entire Part B deductible each year ($283 in 2026).
• Medicare Part B excess charges: If your provider charges more than the Medicare-approved amount, you pay the difference-Plan K does not assist here.
• Foreign travel emergency medical care: Plan K does not provide coverage for emergency care abroad �cand is not suited for frequent travelers outside the U.S.
• Prescription drugs: Medigap plans no longer cover prescriptions; you’ll need a separate Part D plan for drug coverage.

If you want a broader overview of coverage for items such as durable medical equipment, see What Part of Medicare Covers Durable Medical Equipment?

Who Should Consider Plan K?

Medigap Plan K is best suited for:

• Beneficiaries seeking lower monthly premiums in exchange for higher cost-sharing at the point of care.
• Individuals who are relatively healthy and do not expect frequent or significant medical expenses, but want a financial safety net for unexpected high medical costs.
• Those comfortable with paying 50% of many covered medical costs until reaching the annual out-of-pocket cap.
• New Medicare enrollees or those comparing several Medigap options who wish to balance predictable insurance costs with some up-front risk sharing.

If you need assistance with the enrollment process or determining your eligibility, our article How Do I Learn About Medicare Coverage and Enrollment? provides detailed, step-by-step guidance for seniors and their caregivers.

For those considering plan options, understand that Plan K, compared to more “full coverage” Medigap plans like Plans F or G, trades higher cost-sharing for the peace of mind of a guaranteed out-of-pocket cap each year.

2026 Plan K Costs and Premiums by State

Plan K is designed for affordability, and its monthly premiums are generally lower than more comprehensive Medigap plans. However, premiums vary based on your state, zip code, age, gender, tobacco use, and individual insurer pricing. The following are typical monthly premium ranges for Medigap Plan K in 2026 across select U.S. cities:

• West Covina, CA: $78-$397
• El Paso, TX: $63-$233
• Delray Beach, FL: $96-$704
• Chicago, IL: $76-$252
• Philadelphia, PA: $72-$235
• Hamilton, OH: $61-$213
• Lakewood, NJ: $58-$405
• Ridgewood, NY: $88-$153
• Charlotte, NC: $56-$215
• Woodbridge, VA: $61-$205

2026 Out-of-Pocket Limit for Plan K: $8,000. Once you pay $8,000 in plan-eligible out-of-pocket costs, all further covered expenses are paid by the plan for the rest of the year.

City & State	2026 Estimated Monthly Premium Range
West Covina, CA	$78-$397
El Paso, TX	$63-$233
Delray Beach, FL	$96-$704
Chicago, IL	$76-$252
Philadelphia, PA	$72-$235
Hamilton, OH	$61-$213
Lakewood, NJ	$58-$405
Ridgewood, NY	$88-$153
Charlotte, NC	$56-$215
Woodbridge, VA	$61-$205

Comparison: Plan K vs Plan L

Medigap Plan L is closely related to Plan K, but covers 75% rather than 50% of most eligible expenses and has a lower out-of-pocket limit (projected at $4,000 for 2026). However, Plan L’s premiums are usually higher. If you want more robust cost coverage but still want a spending cap, compare these two carefully. Our Medicare Supplement comparison page offers a comprehensive analysis between all Medigap options, including Plan K and Plan L.

How to Enroll in Plan K

The best time to enroll in Medigap Plan K is during your Medigap Open Enrollment Period-this six-month period begins the first month you are both 65 years old and enrolled in Medicare Part B. During this time, you have guaranteed issue rights: insurance companies cannot deny you coverage or charge more because of pre-existing conditions.

Enrollment Steps:

1. First, ensure you are enrolled in Medicare Part B.
2. Research Medigap Plan K options and premiums in your state.
3. Apply directly with your chosen private insurance company.
   • You may consult a licensed Medicare agent or reach out to your local State Health Insurance Assistance Program (SHIP) for free counseling and enrollment help.
4. Submit your application and work with the insurer to complete any required forms.
5. Once approved, pay the insurer directly for your monthly premium.

For a step-by-step overview, visit our Medicare enrollment resource-especially invaluable for first-time enrollees or those who have misplaced their Medicare information (see Lost Medicare Card: What to Do Next).

Important: You cannot have both Medigap (Plan K or any other) and a Medicare Advantage plan at the same time.

Frequently Asked Questions about Plan K

Question	Answer
Is my acceptance guaranteed?	Yes, if you apply during your Medigap Open Enrollment Period or have guaranteed issue rights due to other qualifying events.
Can I be denied for pre-existing conditions?	You cannot be denied during your Open Enrollment Period. Outside this window, medical underwriting may apply, and coverage for pre-existing conditions may be delayed up to six months if you lack prior creditable coverage.
Can I switch to Plan K later?	Yes, but outside your Open Enrollment Period, acceptance is not guaranteed unless you qualify for a special circumstance.
Does Plan K renew automatically?	Yes, your policy will renew automatically as long as you pay your premiums on time.
Can I have Plan K and Medicare Advantage?	No, you cannot be enrolled in both a Medicare Advantage plan and a Medigap plan at the same time.
Does Plan K cover prescription drugs?	No. You will need to join a separate Part D plan to get prescription drug coverage.
What happens if I lose my Medicare card?	You can find instructions for replacement in our article Lost Medicare Card: What to Do Next.
Are Plan K benefits standardized?	Yes, Plan K benefits are the same nationwide, but costs and participating insurers will vary by location.
How do I compare Plan K to other Medigap plans?	See our Medicare Supplement comparison guide for detailed side-by-side comparisons of all available Medigap options.