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Medicare Supplement Plan M

What is Medicare Supplement Plan M?

Medicare Supplement Insurance: Plan M coverage

Medigap Plan M covers the following costs and benefits:

  • Part A hospital coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
  • Part A hospice care coinsurance payment or copayment
  • 50% of Part A deductible costs
  • Part B copayment or coinsurance payment
  • First three pints of blood for a medical procedure
  • Skilled nursing facility (SNF) care coinsurance
  • 80% of foreign travel emergency coverage (up to plan limits)

Medicare Supplement (Medigap) Plan M benefits are the same as those of Medigap Plan D, except that with Plan M, you pay half of the Medicare Part A deductible (while Medigap Plan D covers the entire Part A deductible).

Medigap Plan M does not cover the Medicare Part B deductible or excess charges. Part B “excess charges” are additional costs outside of the Medicare-approved charge.

Medigap Plan M has no out-of-pocket limit, meaning you must pay any out-of-pocket costs that aren’t covered by Original Medicare or Medigap Plan M. When a Medigap plan has an out-of-pocket spending limit, it means that once you’ve spent that amount on out-of-pocket costs and your yearly Part B deductible, your plan will pay 100% of covered services for the rest of the calendar year.

The best time for beneficiaries to enroll in Medicare Supplement Plan may be during their Medicare Supplement Open Enrollment Period, which is not the same for everyone.

This period begins on the first day of the first month that you are both age 65 or older and enrolled in Medicare Part B, and lasts for six months. During this time, private insurance carriers may not use medical underwriting to assess a beneficiary’s health condition.

This means that if you’re enrolled in Medicare Part A and Part B and live within a Medigap plan’s service area, you can enroll in that Medigap plan without fear of being denied coverage or charged higher premiums based on a pre-existing health condition (although waiting periods may apply).

*Medigap plans do not include prescription drug benefits; if you’re enrolled in Original Medicare and want coverage for your medications, you should enroll in a stand-alone Medicare Prescription Drug Plan.

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