Medigap Plans K and L: Lower Premiums With an Out-of-Pocket Limit

Plans K and L are two Medigap plans that often cost less each month. Medigap is also called Medicare Supplement. These plans pay a share of your costs at first. Then, after you reach a set yearly limit, they pay all of your covered costs for the rest of the year. This guide explains how that trade works. Our Medicare Supplement section holds more guides on plan letters.

Watch the video

How Medigap works at all

Medigap works with Original Medicare. Medicare pays its share first. Then your Medigap plan pays its share of the rest. You must keep Part B and pay its premium. You also pay a premium to the company that sells the Medigap plan.

Plan letters are set by law. A Plan K from one company covers the same base benefits as a Plan K from any other company. The price can differ a lot by company. So you shop on price and on how the price may rise over time.

Our Plan G vs Plan N guide shows two plans that pay more of your costs from the start. Our Medicare Select guide shows plans that use a network to hold costs down.

How Plan K pays

Plan K pays a part share for many costs. For most covered costs, it pays half. For some, the share is set by the plan chart. You pay the rest.

You keep paying your share until the total you have paid for covered costs in the year reaches the Plan K limit. In 2026 that limit is $8,000 (Ledger L2). From January 1, 2027, it is $8,360 (Ledger L2).

After you meet that limit and you have met the Part B deductible, Plan K pays 100% of covered services for the rest of that year. The Part B deductible in 2026 is $283 (Ledger A2).

Plan K does not cover all costs. It does not pay the Part B deductible for you. Costs that are not covered services do not count in the same way. Read the plan outline before you buy.

How Plan L pays

Plan L pays a larger share than Plan K for many costs. For most covered costs, it pays three parts in four. You pay the rest.

Its yearly limit is lower. In 2026 the Plan L limit is $4,000 (Ledger L3). From January 1, 2027, it is $4,180 (Ledger L3).

After you meet that limit and the Part B deductible, Plan L pays 100% of covered services for the rest of that year. The Part B deductible rule is the same as for Plan K (Ledger A2).

Since the limit is lower, a person with high care costs hits the full pay point sooner on Plan L than on Plan K. That is the key gap between the two plans.

How the limit builds up over a year

Each covered bill adds a small part to your running total for the year. Medicare pays first, then your plan pays its share, and the part left for you is the part that counts toward the limit. In a light year, that total may stay well under the limit, and you pay your share on each bill all year. In a heavy year, with a hospital stay or a lot of care, the total can climb fast. Once it reaches the limit for your plan, and the Part B deductible is met, the plan steps up and pays the full share for covered care from then on. That change is the main value of these plans in a bad year.

Side by side, in words

See slot 7 in this group, the guide on Medigap foreign travel emergency coverage, for a benefit Plans K and L are often asked about. Check that guide before you count on travel cover from these plans.

• Premium: both plans tend to cost less than plans that pay from the first dollar. No amount is stated here, as companies set the price.
• Share you pay: Plan K leaves you a larger share of each bill than Plan L.
• Yearly limit: Plan K $8,000 in 2026, then $8,360 in 2027 (Ledger L2). Plan L $4,000 in 2026, then $4,180 in 2027 (Ledger L3).
• After the limit: both pay 100% of covered services for the rest of the year, once the Part B deductible is met.
• Best fit by use: a healthy person who uses little care may like the lower premium. A person with high costs may hit the limit and then have a quiet rest of the year.

Who pays for what

• Original Medicare pays its share of covered care first.
• Your Medigap Plan K or L pays its set share of the rest, then 100% after its yearly limit and the Part B deductible are met (Ledger L2 and L3, A2).
• You pay the Part B premium, the Medigap premium set by the company, and your share of costs until the limit.
• Medicaid can help some people with premiums and costs if they qualify through their state.
• Private pay covers premiums and any care Medicare does not cover.

Sample situation

Tom is 66 and is in good health. He sees a doctor twice a year and takes one drug. He is quoted a low premium for Plan K and a higher one for a plan that pays more from the start. He reads the limit rule. In 2026 the Plan K limit is $8,000 (Ledger L2). He knows he would have to pay his share up to that point if he had a bad year, after the $283 Part B deductible is met (Ledger A2). Tom can hold that risk in his savings, so he picks Plan K for the lower premium. He sets aside funds for the share he may owe, so a bad year would not catch him with no plan to pay it.

Questions to ask before you buy

• What is the premium now, and how has it risen in past years for people my age?
• Does the price go up as I age, or is it set by the group?
• How do I file a claim, and does the plan pay the provider direct?
• What costs do not count toward the yearly limit?
• When can I switch plans later, and will health questions be asked then?

Sources

• https://www.cms.gov/medicare/health-drug-plans/medigap/k-l-out-of-pocket-limits-announcements
• https://www.medicare.gov/basics/costs