Medigap Plan M

Medigap Plan M is one of the newest of the 10 standard Medigap Plans. It was created by the Medicare Modernization Act, which was signed into law in 2003. As a supplemental plan, Plan M helps cover most costs not paid for by your Original Medicare Part A and Part B. Unlike most Medigap Plans though, Plan M uses
cost-sharing to help keep your premiums lower. 

What Does Medigap Plan M Cover?	Jump to
What’s Not Covered by Medigap Plan M?	Jump to
Is Medigap Plan M Right for Me?	Jump to

What does Medigap Plan M Cover?

Medigap Plan M covers 7 out of the 9 standard Medigap benefits. Although, unlike most other Medigap Plans,
this one requires you to split the cost of the Part A deductible 50/50.

• Medicare Part A coinsurance & hospital costs  
• Medicare Part B coinsurance or copayments  
• First 3 pints of a blood transfusion  
• Part A hospice care coinsurance or copayments ( 
• Skilled nursing facility care  
• Medicare Part A deductible (50%) 
• Foreign travel emergency care

The 7 standard Medigap Plan M benefits explained:

1. Medicare Part A coinsurance and hospital costs
   Medigap Plan M covers your Part A coinsurance and hospital costs for days 61 through 150. In addition,
   this benefit covers up to 365 more hospital days after your Medicare benefits are used up.ⁱ  
2. Skilled nursing facility care
   Original Medicare pays all your skilled nursing care costs for the first 20 days. Typically, you’re responsible for paying for any days after that. Medigap Plan M pays your share for days 21 through 100.
   
   Note: Neither Original Medicare nor Medigap Plans pay for any skilled nursing care longer than 100 days.
3. Medicare Part B coinsurance or copayment
   Medigap Plan M pays for your Part B coinsurances and copayments which are typically 20% of the Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment.ⁱ 
   
   Note: Medicare Part B coinsurances and copayments don’t kick in until after you’ve paid your Part B deductible. With Medigap Plan M, you are still required to pay your Part B deductible. ⁱ 
4. First 3 pints of a blood  
   Medigap Plan M covers the first three prints of blood per year. ⁱ  
5. Medicare Part A hospice care coinsurance or copayment
   Medigap Plan M covers your coinsurance for palliative drugs and respite care under the Part A hospice benefit, which is usually 5%. ⁱ 
6. Medicare Part A deductible
   Original Medicare Part A charges deductibles per benefit period before your Medicare benefits can kick in.
   In 2022, the Part A deductible is $1,556ⁱⁱ. Medigap Plan M covers this cost for you.
7. Foreign travel care
   Original Medicare doesn’t typically cover health care while you’re traveling abroad. However, Medigap Plans M will cover up to 80% of covered foreign travel emergency care if it begins during the first 60 days of your trip.ⁱⁱⁱ   

What’s Not Covered by Medigap Plan M?

There are two standard Medigap benefits NOT covered by Plan M, including:

• Part B deductibles 
• Part B excess charges 

Regardless of which Medigap Plan you buy, it will not cover:

• Routine dental, vision or hearing services
• Eyeglasses or contacts
• Hearing aids
• Long-term care or custodial care
• Prescription drugs

How Much Does Medigap Plan M Cost?

Like any Medigap Plan, Plan M comes with monthly premiums. These premiums are set by the insurance company selling the plan and can vary widely by region. There are also several other factors that impact rates like your age, your gender, whether you use tobacco products, if you qualify for any discounts and more. 

It’s best to compare Medigap plans in your area from as many insurance companies as possible. Carriers can offer the same exact plans at different rates. So, comparison shopping will help you find the best rate available to you.  

Note: You’ll still be responsible for paying your monthly Medicare Part A and Part B premiums – although most people don’t have Part A premiums. Make sure to factor in these costs when considering Medigap premiums. 

Does Medigap Plan M have a max out-of-pocket?
Medigap Plan K and Plan L feature more extensive cost-sharing, so they also come with maximum out-of-pocket (MOOP) limits to help manage your spending. Since the cost-sharing in Plan M is minimal, this plan does not feature a MOOP. 

Is Medigap Plan M Right for Me?

Whether Medigap Plan M is right for you is going to depend on your health status, budgetary restrictions and lifestyle. It’s also going to depend on how often you visit the doctor, whether you travel abroad, if you prefer to pay less up front for your healthcare in turn for higher out-of-pocket costs.

A Medigap Plan M might be right for you if you:

• Want to pay less up front in premiums
• Are ok with paying 50% of your hospital deductible
• Only use providers that accept Medicare assignment
• Visit the doctor and/or hospital in-frequently
• Live in a state that does not allow Part B excess charges

Medigap Plan M Alternatives
There are two other Medigap Plans that use cost sharing: Plan K and Plan L. Both include the same standard benefits; however, they require more cost sharing than Plan M. Because of this, they could have lower monthly premiums, but more out-of-pocket costs. So, you’ll have to determine whether you’re more comfortable trading higher coinsurances for lower monthly premiums.

There are a few plans that are more popular than others, and Plan M isn’t usually at the top of the list.
You can learn more about the top Medigap plans here. 

If you need help determining which plan is best for you, Ensurem has licensed agents ready to answer your questions. They can also help you compare Medigap plans available in your area from some of the nation’s
top-rated carriers.  

Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there,
it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets CMS regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions. Learn more here.