What is Medicare Supplement Plan M?

Comprehensive coverage with 50% coverage for the Part A deductible

Plan M is one of the 10 standardized Medicare Supplement (Medigap) plan options available for purchase in most states. (For reference, ‘Medigap’ is another term often used for Medicare Supplement. We will use them interchangeably.)

The goal of Medicare Supplement insurance is to fill in some of the out-of-pocket costs left over after Original Medicare (Parts A & B) coverage.

The 10 standardized plans cover varying degrees of your Original Medicare deductibles, copays, and coinsurance. Medicare Supplement plans are labeled: A, B, C, D, F, high deductible F, G, K, L, M, N.

(Be careful not to confuse Medigap plans A, B, C and D with Medicare Parts A, B, C and D. They are different.)

Medigap plans are not endorsed the U.S. government or the federal Medicare program. Like all Medigap plans, a Plan M will have the same benefits no matter which insurance carrier you buy your policy from. The only difference between a Plan M from Humana, a Plan M from Aetna, a Plan M from UnitedHealthcare AARP, or a Plan M from any other insurance carrier will be the price.

What is Different about Plan M

Plan M offers a unique combination of full coverage and cost sharing. Medigap Plan M offers very similar coverage to Plan D and Plan N, but it has cost sharing on an area of coverage.

Cost-sharing: If you choose to go with a Plan M, your insurance carrier will only pay 50% of the costs for Medicare Part A deductible of $1,364.

The only other Medigap plans that offer cost sharing are Plan K and Plan L; however they offer cost sharing on several Medicare costs, including the Part A deductible.

Plan L and Plan K also have out of pocket limits ($2,780 and $5,560 respectively), but Plan M does not.

Coverage Example for Medicare Plan M

Unlike a traditional deductible, the Part A deductible is per benefit period, not annual.  A benefit period begins the day or admission to a hospital or skilled nursing facility and ends 60 days after the stay ends.  

If you are hospitalized in January, June and November, you could be responsible for paying the Medicare Part A deductible three times! With Plan M, you will only be responsible for 50% of the Part A deductible each time = $682.

Medicare Supplement Plan M Popularity

Medicare Supplement Plan M is not particularly popular, but it is a great fit for certain individuals. If you’re looking for a relatively cheap Medigap plan that has an out-of-pocket-limit and some cost sharing along the way, Plan M is worth a look if it’s available in your state.

Medicare Supplement Plan M Coverage 

As we previously mentioned, the goal of Medicare Supplement insurance is to fill in some of the out-of-pocket costs left over after Original Medicare coverage.

Medigap Plan M covers 100%

  • Medicare Part A coinsurance and hospital costs up to 365 days after Original Medicare benefits are exhausted
  •  First three pints of blood for a medical procedure
  • Medicare Part B coinsurance
  • Medicare Part A hospice care coinsurance
  • Skilled Nursing Facility care coinsurance

Medigap Plan M covers 50%

  • Medicare Part A deductible ($1,364 for each benefit period you use in the year)

Coinsurance is the amount left over after the 80% covered by Original Medicare

Medigap Plan M covers 80%

  • Medicare Part A deductible ($1,364 for each benefit period you use in the year)

Medigap Plan M does not cover

  • Medicare Part B deductible ($185 per year in 2019)
  • Medicare Part B excess charges
  • Foreign travel emergency coverage

Why else you might want a Medicare Supplement policy

Medicare Supplement Plan M is just one of the Medigap plans available. It’s important to compare Medigap plans and choose the option that’s best for your healthcare needs (now and down the road) and your budget.

Anyone who has Original Medicare (Parts A & B) is eligible to buy a Medigap plan. You cannot however buy a Medigap plan if you opted in for a Medicare Advantage plan.

Beneficiaries who went without a Medicare Supplement plan spent an average of $5,374 on out-of-pocket costs in 2016, according to a study by the Commonwealth Fund, more than twice what those with a Supplement plan spent.

The best time to purchase a Medicare Supplement plan is during your personal initial enrollment period. Initial enrollment period is the first six months after you’re both 65 years old and enrolled in Medicare Part B. The typical enrollee will coordinate their Medigap policy to begin on the month they turn 65.

You can still buy a plan later, but you may have to go through medical underwriting. Underwriting could mean higher premiums or having a pre-existing condition not covered.

Medicare Advantage

You cannot have a Medicare Supplement Plan M with Medicare Advantage.

Medicare Advantage (Part C) is an alternative offered by private insurance companies to replace Original Medicare (Parts A & B) and typically offers additional benefits. Medicare Advantage plans often limit your coverage to a particular network of healthcare providers. Plans that allow you to see out-of-network providers typically charge you more.

You must be enrolled in Medicare Parts A & B to be eligible to apply for a Medicare Advantage plan.

You may pay a premium for your Medicare Advantage plan, in addition to your Part B premium. To be clear, you will still need to pay your Part B premium.

Medicare Part M

Medicare Part M does not exist.

  • Medicare Part A is the hospital insurance portion of Original Medicare
  • Medicare Part B is the medical insurance portion of Original Medicare
  • Medicare Part C is Medicare Advantage. Medicare Advantage is an alternative to Original Medicare (Parts A & B) that is offered by private insurers
  • Medicare Part D is Prescription Drug Plans (PDP)
  • Medigap Plan M is one of the 10 standardized Medicare Supplement insurance plans

Shop for Medicare Supplement Plan M

Look at Medicare Supplement Plan M prices with no obligation. Enter your zip code, birthdate, gender and tobacco status to get the most accurate prices. Or, shoot us an email at [email protected], or speak with a licensed insurance agent by calling 917-408-3690.

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