Plan K 50 Percent Share
Plan K splits covered costs 50/50 with you but caps your annual out-of-pocket — 2025 cap: $7,220 — making it the structured-budget option among the cost-sharing plans.
| Feature | Plan K |
|---|---|
| Part A coinsurance share | You pay 50% |
| Part B coinsurance share | You pay 50% |
| Skilled nursing coinsurance share | You pay 50% |
| Annual out-of-pocket cap (2025) | $7,220 — then plan pays 100% |
| Part B deductible | You pay (not counted toward cap) |
| Premium vs G | Typically 35–50% lower |
The cap is the product
Original Medicare has no out-of-pocket ceiling; Plan K installs one. A catastrophic year with K costs you at most $7,220 plus the Part B deductible — versus unlimited 20% shares under A alone. Pair this file with the Plan L comparison to see the 75/25 variant.
Who should not buy K
If your annual usage already exceeds the cap (chronic conditions, frequent infusions), a fuller plan nets out cheaper. K also keeps the Part B deductible outside its cap — read the gaps FAQ before assuming any plan covers everything.
FAQ
Does the K cap include my Part D costs?
No — the cap counts Medigap-covered services only; drug costs live in the separate Part D plan.
Is the K cap per person?
Yes — each spouse needs their own policy with their own cap.
Related reading: Plan L file · All plans · Spouse rules FAQ