By: Eligibility Team

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 $1,364 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.

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.

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What Plan M covers

ServiceIs it covered?
Part A coinsurance (365 days after Medicare stops paying)100%
Part B coinsurance or copayment100%
Blood (first 3 pints)100%
Part A hospice coinsurance or copayment100%
Skilled nursing facility coinsurance100%
Part A deductible50%
Part B deductibleNot covered
Part B excess chargeNot covered
Foreign travel exchange80%
Out-of-pocket limitn/a

Table created using information available at Medicare.gov as of 8/8/19.

Part A deductible

Plan M will chip in to cover 50% of your Medicare Part A deductible, which is $1,364 in 2019 for each hospital stay (called a benefit period). That means Plan M will pay $682 and you will pay $682.

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 $185 (in 2019) 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 a 15% fee 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

Pros

  • Medium-cost premiums
  • Coverage for all coinsurance and copayments

Cons

  • 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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OR

Call to speak with a Licensed Agent

855-802-1206

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