Medicare Part A Coinsurance
Medicare Part A is known as hospital insurance.
When you are admitted for an inpatient hospital stay, Medicare Part A requires coinsurance fees if your hospital stay lasts longer than 60 days.
Plan M fully covers your Part A coinsurance costs.
Medicare Part B Coinsurance and Copayment
Medicare Part B usually charges a coinsurance and copayments for doctor visits and other outpatient care.
Medicare Part B typically pays for 80% of the Medicare-approved amount for covered services.
This means that after you meet your Part B deductible ($226 per year in 2023), you are typically responsible for paying the remaining 20% of the costs for your covered care. This is called your Part B coinsurance.
Plan M fully covers your Part B coinsurance and/or copayments.
First 3 Pints of Blood
If you need a blood transfusion as part of medical treatment, Original Medicare only covers the cost of the fourth pint of blood and beyond.
If you need blood while in the hospital, Medigap Plan M covers the cost of the first 3 pints.
Part A Hospice Care Coinsurance or Copayment
Medicare covers hospice care services, but it requires copayments.
These copayments include $5 for certain prescription drugs and 5% of the Medicare-approved amount for inpatient respite care.
Plan M will pay for your hospice care coinsurance and copays completely.
Coinsurance for Skilled Nursing Facility Care
If you are admitted to a skilled nursing facility for care, you will be required to pay a Part A coinsurance payment if your stay lasts longer than 20 days. The Part A coinsurance cost is $200 per day after day 20 of your stay in 2023.
Plan M pays for the entire Part A skilled nursing facility coinsurance cost.
Medicare Part A Deductible
When you are admitted for an inpatient hospital stay, Medicare Part A requires you to meet a deductible before any of your Part A coverage kicks in. In 2023, the Part A deductible is $1,600 per benefit period.
This deductible isn't an annual deductible, which means you could potentially have to pay for the Part A deductible more than once in a single year.
Medigap Plan M will pay for 50% of your Medicare Part A deductible costs.
Foreign Travel Emergency Care
Original Medicare doesn't typically cover medical care that you receive outside of the United States.
Medigap Plan M pays for 80% of the costs for qualified emergency medical care you receive when traveling abroad.
What Does Plan M Not Cover?
There are only two Medigap benefit areas that are not covered by Plan M.
- Medicare Part B deductible
Before your Medicare Part B coverage will kick in, you must first meet an annual deductible. In 2023, the Part B deductible is $226 for the year.
That means you must pay for the first $226 worth of services or items covered by Part B out of your own pocket.
- Medicare Part B excess charges
Some health care providers don't accept Medicare assignment. This means that they don't accept Medicare reimbursement as payment in full for their services or items.
If you receive care from a non-participating provider (which means they don't accept Medicare assignment), you may be charged up to 15 percent more for the service or item. This is known as an “excess charge.”
Is Plan M Better Than Plan G and Other Medigap Plans?
Plan M is a mid-range Medigap plan similar to Plan N and Plan D.
Plan M is similar to Plan G, except that Plan G covers the Part B deductible and fully covers Part B excess charges.
To see the difference between Plan M and the other standardized Medigap plans, please review the chart below.