Medicare Supplement Plan M: Who’s It For?

December 12, 2019

Medicare Supplement plans are for people on Original Medicare Parts A and B. There are currently 10 supplement plans available, and they work by covering some costs that Medicare doesn’t. That’s why many people call them “Medigap” plans—they fill in the gaps of Medicare.

Plan M covers coinsurance and copayments generously. However, it is less generous when it comes to deductibles and excess charges, so you’ll be responsible for those costs if you select Plan M.

Medicare Supplement Plan M is most similar to Medigap Plan D. The only difference between them is that Plan D covers all of the Part A deductible, while Plan M covers half of it.

We know that’s a lot of letters to follow! If you’re getting lost in the alphabet soup of Medicare, consult our Ultimate Medicare Coverage Guide to learn the lingo.

Plan M: Who is it for?

  • People who don’t expect to visit the hospital often: Plan M pays for just half (50%) of the $1,408 Medicare Part A (hospital) deductible. Most other Medigap plans pay more.
  • People who travel internationally: Plan M covers 80% of emergency medical care while traveling outside the US and its territories. It’s one of six Medigap plans that cover travel emergencies abroad.
  • People who understand how deductibles work: There are three deductibles that people on Plan M must pay before their coverage kicks in.
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Susan is 64 and preparing to retire. She plans to select Original Medicare Parts A and B and is researching Medicare Supplement plans. She rarely visits the hospital but wants some help paying the costs if she does. Susan decides to purchase Medigap Plan M, because it will provide her with 50% coverage of the Part A hospital deductible and emergency medical coverage for an upcoming trip to Mexico for a family wedding.

What Plan M covers

Service
Is it covered?

Part A coinsurance (365 days after Medicare stops paying)

100%

Part B coinsurance or copayment

100%

Blood (first 3 pints)

100%

Part A hospice coinsurance or copayment

100%

Skilled nursing facility coinsurance

100%

Part A deductible

50%

Part B deductible

Not covered

Part B excess charge

Not covered

Foreign travel exchange

80%

Out-of-pocket limit

n/a

Table created using information available at Medicare.gov as of 12/12/19.

Part A deductible

Plan M will chip in to cover 50% of your Medicare Part A deductible, which is $1,408 in 2020 for each hospital stay (called a benefit period). That means Plan M will pay $704 and you will pay $704.

A benefit period starts when you first go into a hospital or inpatient facility and ends when you’ve been out of the facility for 60 days straight. There are no limits to the number of benefit periods you can have in a given year, and they can carry over between calendar years.

Part B deductible

Your Part B deductible is not covered by Plan M, so you’ll be responsible for $198 (in 2020) before Medicare starts covering the cost of your doctor visits. Only two plans currently cover the Part B deductible, and starting in January 2020, no plans offered to new Medicare enrollees will be allowed to cover it.

Part B excess charge

When you see a provider who isn’t contracted with Medicare (also referred to as not accepting Medicare assignment), that provider may bill you up to 15% above what Medicare pays them. This fee is called the excess charge, and Plan M doesn’t cover it.  You’ll want to confirm that each provider you see accepts Medicare assignment before you receive care.

Foreign travel exchange

If you have a medical emergency while traveling outside of the United States and its territories, you’re not covered by Medicare. However, if you have Plan M, it will cover 80% of the cost of your care.

There are a few rules to know: to be covered by Medicare Supplement Plan M, the care must be medically necessary, and it has to begin during the first 60 days of a trip. You must also pay a $250 deductible first, and there is a lifetime payout limit of $50,000.

Medicare Supplement Plan M: What you need to know before enrolling

You may want to sign up for a Medicare Supplement plan during your guaranteed issue window. After you sign up for Medicare Part A and Part B, you have six months to sign up for Medigap plans when you will be accepted, no matter your health status. If you wait until later, you may be denied coverage or charged more.

There are seven states that allow you to get guaranteed coverage at other times. The states are Massachusetts, New York, Connecticut, California, Oregon, Maine and Missouri. If you live in one of these states, consult your state’s health insurance assistance program for additional guidance.

Get Medigap Plan M

Pro Heading
Pros
Pro Bullet Medium-cost premiums
Pro Bullet Coverage for all coinsurance and copayments
Con Heading
Cons
Con Bullet Has several types of deductibles to meet

In summary, Medicare Supplement Plan M can be a good choice if you don’t mind paying some expenses at first in exchange for lower monthly premiums. If you have further questions about Plan M or would like a premium quote, call a licensed agent to begin your application.

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Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Written by
Kathryn Anne Stewart
Kathryn Anne Stewart is a freelance writer who covers the intersection of health and money. She has written for Johns Hopkins Medicine, Weight Watchers, Newsmax Magazine, Franklin Prosperity Report, and the National Hemophilia Foundation, often crafting clear explanations of complex topics. When she's away from her desk, you can find her reading a library book, watching stand-up comedy, or cycling with her husband.
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