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Medicare Supplement Insurance Plan M

Medigap Plan M is one of 10 standardized Medicare Supplement Insurance plan options available in most states.

Medicare Supplement Plan M helps cover a number of costs your Original Medicare (Part A and Part B) coverage doesn’t pay for.

Learn more about Plan M benefits, and find out if it may be a good option for you.

 

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What Is Medicare Supplement Plan M?

Medigap Plan M helps pay for a number of out-of-pocket expenses that Original Medicare doesn’t cover.

Medicare Part A and Part B include things like deductibles, copayments and coinsurance, which must be paid entirely out of your own pocket. With Medigap Plan M, you pay a monthly premium in exchange for having some of those out-of-pocket costs covered for you.

There are nine benefit areas that can be covered by a Medicare Supplement Insurance plan, and each type of plan offers its own combination of coverage for those benefits.

Medigap plans are standardized, which means that the benefits covered by Plan M in one state are exactly the same as Plan M in another state, no matter where or by whom it is sold. 

What Does Medicare Supplement Plan M Cover?

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 coinsurance and hospital costs

Medicare Part B coinsurance or copayment

First 3 pints of blood

Part A hospice care coinsurance or copayment

Coinsurance 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 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 ($185 per year in 2019), 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 $170.50 per day after day 20 of your stay in 2019.

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 2019, the Part A deductible is $1,364 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. For 2019, the Part B deductible is $185 for the year.

    That means you must pay for the first $185 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.

2019 Medigap plans comparison chart

Plan M Enrollment

Plan M is the least common Medigap plan.

In 2017, just 10 percent of all insurance companies that sold Medigap plans carried Plan M as an option.1 That was the least of any plan.

And fewer than one percent of all Medigap beneficiaries were enrolled in Plan M in 2017, making it one of just three plans to have an enrollment share of under one percent. All told, just 4,785 people were enrolled in Plan M in 2017.

How Do I Sign up for Plan M?

If Medigap Plan M seems like a good fit, you can request a free Medigap plan quote online today. Plan M options may be available where you live.

Call to speak with a licensed insurance agent who can help you compare the plans in your area so that you can find a plan that fits your needs.

 

Find Medigap Plan M in your area.

Find a plan

Or call --ms-tfn-- to speak with a licensed insurance agent.


1 AHIP. The State of Medigap 2019. (May, 2019). Retrieved from www.ahip.org/wp-content/uploads/IB_StateofMedigap2019.pdf.

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