Understanding Medicare Supplement Plan M Coverage and Costs
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.
Medicare Supplement Plan M is just one of ten types of Medicare Supplement plans. It has coverage fairly similar to the popular Medigap Plan G, with two key exceptions: it only pays for 50% of the Part A deductible (rather than 100%) and it doesn’t cover Part B excess charges.
Read on to learn more about what Medicare Supplement Plan M covers and what costs you’ll have to pay.
Key takeaways:
Medicare Supplement Plan M is one of ten Medicare Supplement plan types available to Medicare beneficiaries.
Medicare Supplement Plan M covers almost the same amount as the most popular Medigap plan (Plan G), but it only covers 50% of the Part A deductible and doesn’t cover Part B excess charges.
Medicare coverage isn’t one-size-fits-all. We recommend speaking with one of our licensed Medicare Advisors to compare and choose from your Medicare options.
What are Medicare Supplement plans?
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%.
Important note: Massachusetts, Minnesota, and Wisconsin offer a different set of standardized Medicare Supplement plans. These states do not offer a Medigap Plan M.
Benefits of Medicare Supplement plans
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.
Standardization
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.
No restrictive provider networks
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.
No need for prior authorization
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.
Eligibility for Medicare Supplement plans
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.
Comparing Medicare Supplement plans
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.
The different parts and plans of Medicaret can be tricky to navigate. If you need help comparing different plans and deciding on the right one for you, our licensed Medicare Supplement Advisors are here to help! Give us a call at (855)-900-2427 for free, personalized advice.
Medicare Supplement Plan M coverage
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.
What’s covered under Medigap Plan M?
Medigap Plan M covers:
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Part B coinsurance or copayment
Blood transfusion (first 3 pints)
Part A hospice care coinsurance or copayment
Skilled nursing facility care coinsurance
50% of your Part A deductible
80% of travel-abroad emergency medical care
What’s not covered?
Medigap Plan M does not cover:
Part B deductible
Part B excess charges
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:
Long-term care and private nurses
Prescription drugs
Medicare Supplement Plan M costs
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.
Medicare Plan M premiums
Your specific Plan M premium would be priced based on the following factors:
Where you live
Your smoking status
Your age
Your gender
The insurance carrier
Household discounts (offered by some Medigap plans)
Will my Medicare Supplement premium change over time?
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.
Medicare Plan M deductibles
There is no specific Plan M deductible, but you’ll have to pay your Part B deductible and 50% of your Part A deductible.
Medicare Plan M out-of-pocket costs and maximums
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.
How to enroll in a Medicare Supplement Plan M
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.
How to choose the right Plan M
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.
Start today by scheduling a free, personalized consultation or call us at (855) 900-2427.