Medigap Plan M is a supplemental insurance plan offered by private insurance companies to cover some out-of-pocket costs associated with Original Medicare.

Medigap is a supplemental insurance plan you can buy through private insurance companies to help cover some of your costs with Original Medicare. Medicare Supplement Plan M (Medigap Plan M) is one option you can choose for additional coverage.

To be eligible for Medicare Supplement Plan M, you must be enrolled in Original Medicare Part A and Part B. You must also live within an area where an insurance company offers this plan.

Keep reading to learn more about this option, including what it covers, who’s eligible, and when you can enroll.

Medicare Supplement Plan M (Medigap Plan M) is a newer Medigap plan option. This plan is designed for people who want to pay a lower monthly rate (premium) in exchange for paying for half of the annual Part A (hospital) deductible.

The federal government requires private insurance companies to standardize Medigap plans, including Plan M. This means that Medigap Plan M must provide the same amount of coverage regardless of the insurance company.

However, exceptions exist in Massachusetts, Minnesota, and Wisconsin, as these states standardize their plans differently.

The costs of plans may vary by company and state.

Medigap policies are only available to those with Original Medicare (Medicare Part A and Part B.) If you have Medicare Advantage, you can’t have a Medigap plan, as this plan already offers additional coverage.

Medicare Supplement Plan M coverage includes the following:

  • 100% of Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • 50% of the Part A deductible
  • 100% of Part A hospice care coinsurance or copayments
  • 100% of costs for blood transfusions (first 3 pints), after which Original Medicare covers the additional costs
  • 100% of skilled nursing facility care coinsurance
  • 100% of Part B coinsurance or copayments
  • 80% of qualifying healthcare costs while traveling abroad

It does not cover your Part B deductible or Part B excess costs, which you may be charged if you visit a healthcare facility that does not accept Medicare.

Medigap also does not cover services not covered by Original Medicare, such as vision, hearing, or dental.

Because Medigap Plan M offers the same coverage no matter what insurance company provides the plan, the main difference is cost. Insurance companies don’t offer the plans at the same monthly premium, so it makes sense to shop around for the lowest-cost policy.

There are lots of factors that go into what an insurance company charges for Plan M. These include:

  • your age
  • your overall health
  • the ZIP code where you live
  • if the insurance company offers discounts for certain factors, such as being a nonsmoker or paying yearly instead of monthly

To get the best deal on a Medigap plan, it is best to enroll during the initial Medigap enrollment period, which lasts for 6 months once you enroll in Medicare Part B. During this time, insurance companies cannot use medical underwriting when they review and sell you a Medigap plan. This means they cannot deny you coverage or charge you more if you have a preexisting health condition.

Once you choose a Medicare supplement plan, the deductibles can increase on a yearly basis.

However, some people find switching Medigap plans cost them more.

Other out-of-pocket costs

Before selecting a doctor or healthcare facility, check if they accept the Medicare-approved rates, or the price Medicare will pay for the service.

If your doctor does not accept these assigned rates, you can either find another doctor who does or stay with your current doctor. If you elect to stay, the healthcare facility is not allowed to charge more than 15% above the Medicare-approved amount. However, you will be responsible for paying for the difference between the Medicare-approved amount and what the facility charges, known as Part B excess charges.

While some Medigap plans cover Part B excess charges, Medigap Plan M does not.

Payment

After you’ve received treatment at the Medicare-approved rate:

  1. Medicare Part A or B pays its share of the charges.
  2. Your Medigap policy pays its share of the charges.
  3. You pay your share of the charges, if any.

Medicare Supplement Plan M is designed for those who want supplemental coverage at a lower monthly rate in exchange for paying half of the annual Part A and all of the usual Part B deductibles.

If you don’t expect frequent hospital visits and are comfortable with cost-sharing, Medicare Supplement Plan M may be a good choice for you.

Medicare supplement plans help cover some of the “gaps” between the cost of healthcare and what Medicare contributes to those costs.

With Medigap Plan M, you pay a lower premium but share in the costs of your Medicare Part A deductible, Medicare Part B deductible, and Part B excess charges.

Before committing to Medigap Plan M or any other Medigap plan, review your needs with a licensed agent who specializes in Medicare supplements to help you. You can also contact your state’s State Health Insurance Assistance Program (SHIP) for free help in understanding available policies.