Medigap Plan K and Plan L: How the Two Cost-Sharing Plans Compare

Medigap plan K and plan L are two of the standardized Medicare Supplement plans. A Medigap plan is sold by a private insurance company. It may help pay some costs that Original Medicare does not pay, such as certain coinsurance amounts.

Plans K and L are called cost-sharing plans. They cover a portion of certain benefits, and you pay the rest until you reach an annual out-of-pocket limit set under the plan rules. Plan L generally covers a larger share of those benefits than Plan K. Plan M is a third cost-sharing option, so you may see all three discussed together.

Plans K and L are among the letters sold to people newly eligible for Medicare. These are Plans A, B, D, G, K, L, M and N, plus high-deductible Plan G. Plans C and F are only for people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. Massachusetts, Minnesota and Wisconsin standardize Medigap differently. 1-800-MEDIGAP is an independent, privately run educational site. It is not Medicare.gov, CMS, Social Security or any government agency.

People have often looked at Plans K and L when they want a Medigap plan with a different balance between monthly premium and what they pay when they use care. Because you share costs, the monthly premium may be lower than for plans that cover more. Premiums vary by carrier, state and age.

Others have preferred plans that cover more of the cost-sharing, such as Plan G or Plan N, because they like knowing what to expect. Some people compare K and L against those plans side by side. Neither approach is right for everyone.

Medigap is also often compared with Medicare Advantage. Medigap lets you use any provider nationwide that accepts Medicare, with no network or referrals, and its cost-sharing is predictable. Trade-offs may include generally higher monthly premiums, possible medical underwriting outside open enrollment or guaranteed issue, a separate Part D plan for drugs, and no routine dental, vision or hearing. Medicare Advantage often has lower premiums, an annual out-of-pocket maximum, extra benefits and drug coverage in many plans. Its trade-offs may include networks, prior authorization and copays.

A Medigap agent who is licensed in your state may help you sort through the letters. Agents who work with several carriers may be able to explain how Plan K and Plan L are offered in your area. They can also show how those plans compare with Plans G, N and others.

A conversation is usually relaxed. The agent may ask which doctors and hospitals you use, how often you need care, and how you feel about paying costs as they come up. They may also ask when you first became eligible for Medicare, because that affects which plan letters you can buy.

Good questions to bring include: How does the out-of-pocket limit work on Plan K versus Plan L? Which benefits are shared and which are covered in full? Do I have open enrollment or guaranteed issue rights right now? How would I cover prescription drugs? Call 1-800-MEDIGAP for more information. Confirm current rules with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.