Plan K vs Plan L: Structured Cost-Sharing Compared
Plans K and L are the only Medigap letters built on percentage cost-sharing instead of full coverage. K splits approved costs 50/50 with you until an annual out-of-pocket cap; L pays 75% against a lower cap. Both caps are federal maximums set each year, and both plans exist for one purpose: capping your worst-case year.
| Dimension | Plan K | Plan L |
|---|---|---|
| Cost share (you / plan) | 50% / 50% | 25% / 75% |
| 2025 out-of-pocket cap (federal max) | $7,220 | $3,610 |
| Part B deductible | Not covered — 50/50 split | Not covered — 25/75 split |
| Part A hospice / blood / home health | 50% share | 75/25 share |
| Typical premium vs G | 30–45% cheaper | 25–40% cheaper |
| Foreign travel emergency | Not covered | Not covered |
How the caps actually bind
The caps are ceilings, not targets — a healthy year on K might cost you only $400 in split claims, far under $7,220. The cap earns its keep in catastrophic years: with $200,000 of covered costs, K holders stop at $7,220 out of pocket while an uncovered scenario would be ruinous. L’s $3,610 cap is meaningfully better protection, which is why its premium runs closer to G. Note the caps are maximums carriers may charge less against, but never more.
Who K and L actually fit
K fits disciplined savers who want catastrophic insurance at the lowest entry price and can tolerate a four-figure bad year. L fits the same person with slightly less tolerance for volatility. Neither fits anyone who wants predictable monthly billing with no claim anxiety — that is G or N. And because switching later requires underwriting in most states, buyers should assume they may hold K or L for a decade, not a one-year trial.
FAQ
Do K and L cap amounts change every year?
Yes — CMS publishes new federal maximums annually. The 2025 figures are $7,220 (K) and $3,610 (L).
Does Plan K cover the Part B deductible?
No — it splits 50/50 until your share hits the annual cap; there is no separate deductible coverage.
Are K and L available everywhere?
Not in Massachusetts, Wisconsin or Minnesota, which standardize their own product menus instead.
Related reading: Plan K full file · Plan L full file · Plan G for contrast · All Medigap plans