Medicare Supplement Plan K: 2026 Coverage, Cost, Eligibility

Medicare is a lot like buying a plane ticket: the “base fare” looks reasonable, and then the fees show up like
surprise passengers. Original Medicare (Part A and Part B) is excellent coverage, but it doesn’t cap your yearly
out-of-pocket costs the way many people assume. That’s where Medicare Supplement Insurance (also called Medigap)
comes inpolicies sold by private insurers to help pay certain deductibles, copays, and coinsurance left behind by
Original Medicare.

Medigap Plan K is the “lower premium, higher cost-sharing” cousin in the Medigap family. In 2026, it’s especially
appealing if you want protection from runaway bills but you’re okay paying a meaningful share along the way.
Think of it as a financial seatbelt: not full bubble wrap, but a lot better than going without.

What You’ll Learn

• What Plan K is (and who it’s for)
• Plan K coverage in 2026, explained simply
• How the 2026 out-of-pocket limit works (and what it doesn’t include)
• Eligibility and the best time to enroll
• What Plan K costs in 2026 (and what you’ll actually spend)
• Plan K vs. Plan G, Plan N, and Plan L
• How to shop smart (without losing your weekend)
• FAQ
• Real-world experiences and scenarios (extra 500+ words)

Quick Snapshot: What Plan K Is (and Isn’t)

Medigap Plan K is a standardized Medicare supplement plan in most states. “Standardized” means a Plan K from one
insurer must cover the same benefits as a Plan K from another insurerthe big difference is the premium you pay
and how the company prices it.

Here’s the headline: Plan K typically pays 100% of a couple major hospital-related gaps, but only
50% of many other cost-sharing items. In exchange, premiums are often lower than “richer” plans
like Plan G. Plan K also has one feature many people love: a yearly out-of-pocket limit (a safety
rail for your wallet), which is rare among Medigap plans.

Important nuance: Plan K helps cover Medicare-approved cost sharingit does not replace Medicare, and it
is not the same thing as a Medicare Advantage plan. You keep Original Medicare, and you add Plan K on top.

2026 Coverage: What Medicare Supplement Plan K Pays For

Plan K benefits are easiest to understand using the official Medigap benefit categories. The table below reflects
the standard Plan K design in most states (Massachusetts, Minnesota, and Wisconsin standardize Medigap differently).

Plan K benefit breakdown

Translation: Plan K is designed to reduce your exposure to big hospital-related costs and put a ceiling on
qualifying cost-sharingwhile still requiring you to pay meaningful portions of many items.

How the 2026 Out-of-Pocket Limit Works (This Part Matters)

Plan K is one of the few Medigap plans with a yearly out-of-pocket limit. For calendar year 2026,
the out-of-pocket limit for Plan K is $8,000.

Here’s the key “fine print without the tiny font”: once you reach your Plan K out-of-pocket limit
and you’ve paid your yearly Part B deductible, Plan K pays
100% of covered Medicare cost-sharing for the rest of that calendar year.
In 2026, the standard Medicare Part B deductible is $283.

What the out-of-pocket limit does NOT include

• Your monthly premiums (Part B premium and your Medigap premium don’t count toward the limit).
• Costs that Plan K doesn’t cover (like Part B excess charges, or services not covered by Medicare).
• Many people are surprised by this:
  the Part B deductible is separateyou must meet it in addition to hitting the Plan K limit.

A simple 2026 example (numbers you can picture)

Let’s say you have a year with frequent outpatient care: imaging, physical therapy, specialist visits, and a couple
outpatient procedures. Under Original Medicare, after you pay the Part B deductible, you generally owe 20% of
Medicare-approved amounts for many services. With Plan K, the plan covers 50% of that Part B
coinsuranceso instead of paying 20%, you’re often paying roughly 10% of Medicare-approved charges
(plus any non-covered items).

Over time, those 10% shares add up. If your qualifying out-of-pocket spending reaches $8,000 in 2026
(and you’ve also paid your $283 Part B deductible), Plan K steps in to pay
100% of covered cost-sharing for the rest of the year. That “rest of year” protection is the
whole point of Plan K: it limits the damage during a medically expensive year.

What Plan K Doesn’t Cover (So You’re Not Shocked Later)

Plan K is a Medigap plan, not a magical all-inclusive resort wristband. Here are the common gaps you’ll still need
to plan for:

• Prescription drugs (that’s typically Part D territory).
• Routine dental, vision, and hearing (Original Medicare generally doesn’t cover these; neither does Plan K).
• The Medicare Part B deductible (you pay it in full).
• Part B excess charges (important if a provider doesn’t accept Medicare assignment).
• Foreign travel emergency (some other Medigap plans offer limited foreign travel coverage; Plan K doesn’t).

Eligibility: Who Can Buy Medicare Supplement Plan K in 2026?

In general, you can buy Medigap Plan K if:

• You have Original Medicare (both Part A and Part B).
• You live in a state where Plan K is sold (availability varies by state and carrier).
• You’re not enrolled in a Medicare Advantage plan (Medigap is designed to work with Original Medicare, not Advantage).

Big state note

If you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies are standardized
differently than the lettered plans used in most states. That doesn’t mean you can’t get supplement coverageit
means you’ll be shopping within your state’s standardized options rather than a “Plan K” label.

The best enrollment window: your Medigap Open Enrollment Period

Under federal rules, you get a 6-month Medigap Open Enrollment Period that starts when you’re
65 or older and your Medicare Part B coverage begins. During this period, insurers
generally can’t use medical underwriting to deny you coverage or charge more because of health conditions.

Outside open enrollment: underwriting is usually the boss

If you apply for Plan K outside your Medigap Open Enrollment Period, there’s generally no federal guarantee an
insurer must sell you a policy. If you can buy it, you may pay more based on health history, or you may be denied,
depending on your situation and state rules.

Guaranteed-issue situations

Some situations give you “guaranteed issue” rights (meaning you can buy certain Medigap policies without medical
underwriting). Examples can include losing certain types of coverage, your plan leaving Medicare, or specific trial
rights when switching from Medicare Advantage back to Original Medicare. The details are situation-dependent, so
it’s worth checking the rules before you cancel any existing coverage.

2026 Cost: Premiums and What You’ll Actually Spend

Plan K’s premium is set by private insurers, so there’s no single national price tag. Two people can have the same
Plan K coverage and pay very different premiums based on factors like:

• ZIP code / state (local healthcare costs and competition matter).
• Age and tobacco status.
• Pricing method: community-rated, issue-age-rated, or attained-age-rated.
• Household discounts (some insurers discount if more than one person in a household has a policy).
• Timing (buying during open enrollment vs. later).

Don’t forget the “Medicare basics” costs in 2026

Even with Plan K, you still pay your Medicare Part B premium. In 2026, the standard Part B premium is
$202.90/month, and the Part B deductible is $283/year. The Part A hospital deductible
in 2026 is $1,736 per benefit period.

What you might pay in a real year (illustrative scenarios)

Scenario 1: A “normal” year with modest outpatient care

• You pay your monthly Part B premium, plus your Plan K premium.
• You pay the full $283 Part B deductible in 2026 if you use Part B services.
• For many Part B services after the deductible, you often pay about half of the normal 20% coinsuranceroughly 10% of Medicare-approved amounts.
• If your care is modest, Plan K can feel like a good deal because the premium is often lower than richer plans.

Scenario 2: A hospital admission in 2026

• Original Medicare charges the Part A deductible: $1,736 per benefit period in 2026.
• Plan K covers 50% of that deductible, so you’d generally pay $868 for that deductible event.
• Plan K covers 100% of Part A coinsurance for hospital days where coinsurance applies, and it also covers hospital costs for an additional 365 days after Medicare benefits are used up.

Scenario 3: Skilled nursing facility (SNF) rehab after a hospital stay

• In 2026, the SNF coinsurance for days 21–100 is $217/day.
• Plan K pays 50%, so you’d generally owe about $108.50/day for those days (if you meet Medicare’s SNF coverage requirements).

These examples show the Plan K tradeoff: you’re protected from the worst-case spiral by the out-of-pocket cap, but
you’re paying a chunk of cost-sharing as you go.

Plan K vs. Plan G, Plan N, and Plan L

Choosing a Medigap plan is mostly about one question: Do you want to pay more in premium to pay less when you get care, or vice versa?

Plan K vs. Plan G

• Plan G is popular because it covers almost all Medicare cost-sharing except the Part B deductible.
• Plan K usually has a lower premium, but you pay more cost-sharing (often half of several categories) until you reach the cap.
• Plan G typically feels best if you want predictability and don’t want to budget for frequent coinsurance.
• Plan K may feel best if you want catastrophic protection and you’re comfortable with some pay-as-you-go costs.

Plan K vs. Plan N

• Plan N often trades lower premiums for certain copays (like some office and ER visits) and it generally doesn’t cover Part B excess charges.
• Plan K reduces Part B coinsurance by half but keeps you paying meaningful shares until the out-of-pocket limit kicks in.
• If you rarely go to the doctor, you might lean toward lower-premium designs. If you go often, comparing how each plan handles outpatient cost-sharing matters.

Plan K vs. Plan L

• Plan L is the “Plan K, but more generous” option: it generally pays 75% of many categories.
• Plan L’s 2026 out-of-pocket limit is $4,000, compared with Plan K’s $8,000.
• Plan L often comes with higher premiums than Plan K, but you may spend less at the doctor’s office.

How to Shop for Plan K in 2026 (Without Regret-Scrolling Later)

1. Confirm you’re in Original Medicare (A and B). Medigap is designed to work with Original Medicare.
2. Check your timing. If you’re in your Medigap Open Enrollment Period, you typically have the best consumer protections.
3. Ask how the premium is priced. Community-rated, issue-age-rated, and attained-age-rated pricing can affect long-term costs.
4. Ask about rate history. A very cheap premium today can be less exciting after repeated rate increases.
5. Make an “excess charge” plan. Since Plan K doesn’t cover Part B excess charges, confirm whether your providers accept Medicare assignment.
6. Compare multiple insurers. Benefits are standardized; the premium, service, and pricing approach differ.
7. Get free help if you want it. Your State Health Insurance Assistance Program (SHIP) can explain options in plain English.

Frequently Asked Questions

Does Plan K cover the Medicare Part B deductible in 2026?

No. You pay the Part B deductible yourself. In 2026, the standard Part B deductible is $283.

Is the Plan K out-of-pocket limit the most I’ll spend in 2026?

It’s the most you’ll spend on covered cost-sharing that counts toward the limit, after which Plan K pays 100%
for covered services for the rest of the year (once you’ve also met the Part B deductible). Premiums and non-covered
expenses do not count.

Can I keep Plan K and enroll in Medicare Advantage?

Generally, no. Medigap policies are intended for Original Medicare, not Medicare Advantage. If you enroll in a Medicare
Advantage plan, your Medigap policy won’t work the way you expect (and you may not be able to buy Medigap later without underwriting).

Can people under 65 buy Plan K?

It depends on your state. Some states require insurers to offer at least certain Medigap plans to beneficiaries under 65
(often people on Medicare due to disability), while others have different rules.

Does Plan K include dental, vision, or hearing?

No. Plan K is designed to cover certain Medicare cost-sharing gaps, not extra benefits like routine dental or vision care.

Is Plan K “good”?

It’s “good” if it fits your budget and your risk tolerance. Plan K can be a smart match if you want lower premiums and a
hard ceiling on qualifying cost-sharing, and you’re okay paying a share of costs along the way.

Conclusion

Medicare Supplement Plan K in 2026 is a practical middle path for people who want real protection without paying for
the most comprehensive Medigap coverage. You’ll still pay the Part B deductible and a meaningful share of many costs,
but you’ll also get a defined safety net: the $8,000 out-of-pocket limit (plus the Part B deductible),
after which Plan K pays 100% of covered services for the rest of the year.

If you like the idea of lower monthly premiums and can handle some variable cost-sharingespecially in exchange for a
clearly defined “worst-case” ceilingPlan K is worth a serious look. Just shop carefully, understand underwriting rules
outside open enrollment, and make sure you have a plan for prescriptions and any extras Medicare doesn’t cover.

Real-World Experiences and Scenarios (500+ Words)

People don’t usually wake up and say, “Ah yes, today feels like a thrilling day to compare coinsurance percentages.”
What actually happens is more human: a premium jumps, a friend tells a horror story about a hospital bill, or someone
realizes their retirement budget does not include “mystery medical invoices” as a monthly line item.

The “I want a cap, but I don’t want to pay Plan G prices” shopper

A very common Plan K experience starts with sticker shock. Someone compares Plan G premiums in their ZIP code and
thinks, “This is a great plan… and also my grocery budget is now in danger.” Then they notice Plan K and the out-of-pocket
limit. The idea of a safety net is comforting: even if the year goes sideways medically, there’s a ceiling on qualifying
cost-sharing. The tradeoff is psychological as much as financial: you’re accepting more “small pain” (copays/coinsurance)
to avoid “big pain” (unlimited exposure).

The “I’m healthy… until I’m not” reality check

Another classic story: someone chooses a lower-premium plan while they feel great, and it works nicely for a few years.
Then an unexpected knee surgery, a cardiac workup, or physical therapy enters the chat. Under Plan K, outpatient coinsurance
is still sharedso bills show up more often than they would under a richer plan. But many people say the emotional win
is the ceiling: even if you’re paying more as you go, you’re not staring into a bottomless pit.

The “Part B excess charges surprise” (and how to avoid it)

Because Plan K doesn’t cover Part B excess charges, the “provider who doesn’t accept assignment” can become a villain in
your story. Most beneficiaries never run into this problemuntil they do. The real-world lesson: before you fall in love
with a premium, check whether your frequent providers accept Medicare assignment. If they do, you’ve dramatically reduced
the chance of extra charges that Plan K won’t help with. In practical terms, this is less about memorizing policy language
and more about asking one simple question at the front desk: “Do you accept Medicare assignment?”

The “I missed open enrollment” scramble

Some of the most stressful experiences happen when people try to buy Medigap later, after health issues develop. They
learnoften painfullythat outside the Medigap Open Enrollment Period, medical underwriting can apply. That can mean higher
premiums or denial. The takeaway many people share: if you’re leaning toward Medigap at all, the smoothest time to enroll
is when your open enrollment window is active. It’s one of the rare moments in the Medicare universe where the rules are
actually on your side.

The “I travel a lot” disappointment

Plan K doesn’t include foreign travel emergency coverage. So frequent travelers sometimes pick Plan K for its cap and premium,
then realize they need another strategy for overseas protectionlike a travel medical policy. The experience here is usually
not anger, but a “wait, what?” moment. The practical solution is simple: if international travel is a big part of your life,
factor travel coverage into your planning instead of assuming Medigap automatically handles it.

The “budgeting win” mindset shift

When Plan K works well, people often describe a mindset shift: they stop trying to predict every possible medical event and
start planning around boundaries. They treat premiums as the fixed cost, then treat the out-of-pocket limit as the maximum
variable cost (for qualifying expenses). It’s not that healthcare becomes cheapMedicare is not a coupon codebut it becomes
more predictable. For many retirees, predictability is the real luxury.

Bottom line: most Plan K experiences aren’t dramatic. They’re practical. The plan tends to attract people who can tolerate
some cost-sharing, dislike overpaying for richer coverage they may not use, and still want the comfort of an annual “financial
guardrail” if health costs spike. If that sounds like you, Plan K can feel less like insurance jargon and more like a plan you
can actually live with.