Medicare Supplement (also called Medigap) plans were created to provide Medicare beneficiaries with a way to reduce the 20% of costs not covered by Original Medicare. Because they limit your costs, they are pretty common among those on Original Medicare.
Read on to learn more about what Medicare Supplement Plan M covers and what costs you’ll have to pay.
Medicare Supplement (Medigap) plans provide additional insurance that works with Original Medicare. Original Medicare only pays for 80% of covered services, leaving you responsible for the 20% of remaining costs. Medigap plans help with that remaining 20%.
Medigap plans help reduce deductibles, copayments, and coinsurance. If you don't have a Medicare Supplement plan, you'd have to pay the full 20% of what Original Medicare doesn’t pay.
In addition to saving you money on Original Medicare, Medigap plans have three main benefits.
Every Medicare Supplement plan is identical in coverage, regardless of pricing. For example, all Plan Ms cover the same costs, even if monthly premiums or insurance carriers differ.
With Original Medicare and Medicare Supplement, you can go to any doctor or facility that accepts Original Medicare, which is 90% of providers all across the country. This is especially helpful if you travel a lot domestically.
One common complaint about Medicare Advantage is the common need for prior authorization for covered services. If denied prior authorization, you would be responsible for 100% of the cost of the medical service. Original Medicare and Medigap don't require prior authorization for any covered services.
You are eligible for a Medicare Supplement plan if you are enrolled in Original Medicare (Part A and Part B) and not enrolled in Medicare Advantage.
There are ten kinds of Medicare Supplement plans, and each one helps with different out-of-pocket costs. This chart shows how each plan is different.
Compared to other Medicare Supplement plans like Plans G and N, Plan M doesn’t provide the most coverage. Plan M is similar in coverage to Plan G except Plan M only covers 50% of your Part A deductible and doesn’t cover Part B excess charges. Read on to learn what the plan does and does not cover.
Currently, Plan G and Plan N are the most popular Medigap plans among new Medicare beneficiaries because they provide the most comprehensive coverage at a great value.
Medigap Plan M covers:
Medigap Plan M does not cover:
Medicare Supplement plans only provide coverage for out-of-pocket costs leftover by Original Medicare. They will not cover healthcare services not covered by Original Medicare like:
You would be responsible for paying any out-of-pocket costs that Plan M does not cover (outlined above) as well as your Original Medicare and Medigap Plan M premiums.
How much you pay for your premiums will depend on personal factors, where you live, and your insurance carrier.
Your specific Plan M premium would be priced based on the following factors:
There are three pricing or “rating” structures that impact how your Medicare Supplement premiums could change over time based on your plan. Your premiums may also change due to inflation and other economic factors.
If your plan is community-rated (aka no-age-rated), the premium you pay is the same as everyone else with the same policy, regardless of age. This means your premium won’t go up as you age.
If your plan is issue-age-rated (aka entry age-rated), the premium you pay is determined by the age you were when you first enrolled in your Medigap plan. Your premium will not change as you age.
If your plan is attained-age-rated, the premium you pay is based on your current age (the age you’ve “attained”). This means your premium will increase as you age.
There is no specific Plan M deductible, but you’ll have to pay your Part B deductible and 50% of your Part A deductible.
Because Plan M is built to limit how much you pay out-of-pocket, the plan does not have an out-of-pocket maximum. Only two Medigap plans—Plan K and Plan L—have out-of-pocket limits, because they provide less coverage.
If you need help enrolling in a Medicare Supplement plan, our Medicare Advisors can assist you with comparing plans and completing your application. The best time to get a Medigap plan is during your Medigap Open Enrollment Period, which is a six-month window after your Part B starts. During this time, you are guaranteed acceptance into any Medigap plan without any follow-up health questions.
Enrolling in a Medigap plan outside of this period can be harder because insurance companies can ask about your health history. They could reject your application or charge you more based on your health. Learn more about the specifics of Medigap enrollment in this blog.
Since all Plan Ms have the same coverage, you can focus on picking the right plan based on premiums and insurance carriers. Our Medicare Advisors are here to help you understand Plan M and your other Medicare options so you can make the best choice based on your current and future healthcare needs.