Medigap Plan M is a Medicare Supplement Insurance plan that covers some out-of-pocket expenses for Medicare members, including copays, coinsurance and deductibles.
Plan M is nearly identical to Medigap Plan D, which is one of the more comprehensive plans. Here’s the difference: While Plan D covers 100% of the Medicare Part A deductible, Plan M covers only 50%, but Plan M might have lower premiums as a result.
How it works
When Medicare pays for services, you’re responsible for certain out-of-pocket costs unless you have Medicare Supplement Insurance, or Medigap, to help cover them. Medigap plans are only for Original Medicare members — they’re not compatible with Medicare Advantage.
There are 10 standardized Medigap plans available in most states (except Massachusetts, Minnesota and Wisconsin, which use different standards). The plans differ in terms of coverage for services, out-of-pocket limits and premium costs.
Medigap Plan M pays for the full cost of most of the services it covers, but it covers only half of the Medicare Part A deductible. That deductible is $1,556 in 2022, so under Plan M, you would be responsible for $778.
What Medigap Plan M covers
Here’s what Medigap Plan M covers, according to Medicare.gov:
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Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.
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Part A hospice care coinsurance or copayment.
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Part B coinsurance or copayment.
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Skilled nursing facility care coinsurance.
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Blood transfusion (first three pints).
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Emergency health care services for the first 60 days when traveling outside the U.S.
What Medigap Plan M doesn’t cover
Medigap Plan M doesn’t cover one benefit that’s included in some other plans available to new Medicare members: Medicare Part B excess charges (when a provider charges you more than Medicare’s approved amount).
Additionally, all Medigap plans, including Plan M, sold to new Medicare members don’t cover the following:
How much does Medigap Plan M cost?
Medigap plans are standardized and regulated by the government but sold by private companies. Those companies set premiums according to factors including age, location and tobacco use. In a representative North Carolina ZIP code (27406) in 2022, monthly Medigap Plan M premiums for a 65-year-old nonsmoker range from $72 to $260.
To find out what a Medigap Plan M policy would cost you, visit Medicare.gov.
Your Medigap open enrollment period, which starts the first month you have Medicare Part B and are 65 years of age or older, is the easiest and least expensive time to enroll in a Medigap plan. The period lasts for six months, during which companies can’t factor your health or medical history into pricing or coverage decisions.
After your Medigap open enrollment period ends, it never happens again, and insurers can charge more or deny coverage for a new plan due to your health status or medical history.
If you have questions about Medicare, visit Medicare.gov or call 800-633-4227 (TTY: 877-486-2048).
