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Medicare Supplement Insurance Plan M

Medigap Plan M is one of 10 standardized Medicare Supplement insurance options available in most states. (Massachusetts, Minnesota, and Wisconsin have different options.) Plan M is a relatively new plan, so learn more about its benefits to find out if it may be a good option for you.

Medigap Plan M: An Overview

Medigap Plan M was introduced in 2010 and currently has a very limited share of the Medigap market, according to America’s Health Insurance Plans (AHIP).

Keep reading for details on Plan M’s benefits and enrollment rates, in addition to how the benefits compare to other plan options.

Plan M Benefits

Plan M offers full or partial coverage for 7 out of 9 possible Medigap benefits.

Standard Medicare Supplement Insurance benefits

Plan M

Medicare Part A co-insurance and hospital costs

Medicare Part B co-insurance or co-payment

First 3 pints of blood

Part A hospice care co-insurance or co-payment

Co-insurance for skilled nursing facility

Medicare Part A deductible

50%

Medicare Part B deductible

 

Medicare Part B excess charges

 

Foreign travel emergency

80%

Medicare Part A co-insurance: Medicare Part A is known as hospital insurance and it includes cost-sharing measures like co-insurance. Inpatient hospital stays covered by Medicare Part A require co-insurance fees if they exceed 60 days. Plan M pays for all of these co-insurance fees.

Medicare Part B co-insurance and co-payment: Medicare Part B usually charges a co-insurance and co-payments for doctor visits and other outpatient care. Medicare Part B typically pays for 80% of the Medicare-approved amount for covered services, leaving a 20% co-insurance in most cases. Plan M pays the 20% co-insurance or co-payment costs.

With Plan M, the Medicare beneficiary still has to pay the Medicare Part B deductible, which is $185 in 2019.

First 3 pints of blood: Original Medicare only covers the fourth pint of blood and beyond. If you need blood while in the hospital, Medigap plans cover the cost of the first 3 pints.

Part A hospice care co-insurance or co-payment: Hospice care provides medical treatment and care during a terminal illness. Medicare covers these services, but it requires co-payments. These co-payments include $5 for each symptom and pain relief prescription drugs and 5% of the Medicare-approved amount for inpatient respite care. Plan M covers these costs completely.

Co-insurance for skilled nursing facility: Medical care provided at skilled nursing care facilities is covered by this plan. Plan M pays for the entire co-insurance cost.

Medicare Part A deductible: This benefit pays for the deductible on Medicare-approved health care services such as hospice care, skilled nursing facilities, and inpatient hospital stays. Plan M will pay for 50% of the 2019 deductible cost, which is $1,364 per benefit period.

Foreign travel emergency: This benefit provides coverage for medical care provided outside of the United States. This insurance benefit pays for 80% of the billed charges. Coverage is provided after a $250 deductible has been met for the year.

For more detailed information, read our page about Medicare Supplement Insurance benefits.

Plan option comparison

Plan M is a mid-range Medigap plan similar to Plan N and Plan D.

To see the difference between Plan M and the other standardized Medigap plans, please review the chart below.

Plan M vs. other Medigap plan options

Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility 50% 75%
Medicare Part A deductible 50% 75% 50%
MedicarePart B deductible
Medicare Part B excess charges
Foreign travel emergency 80% 80% 80% 80% 80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything. 2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

Plan M Enrollment Statistics

Plan M was launched in 2010 alongside Plan N. It is offered by very few insurers, according to AHIP. Only 9% of Medigap insurance companies offer Plan M and it represents less than 0.5% of the overall market.

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