- Medicare Supplement Plan M is one of 10 different Medigap plan options.
- Plan M is designed for people who want to pay a lower monthly rate in exchange for some cost-sharing.
- Your premiums for Plan M depend on your location, the company you purchase the plan from, and your health.
Many Americans eligible for Medicare also sign up for help with out-of-pocket costs by enrolling in a supplemental insurance, or Medigap, plan.
Medigap plans bridge coverage gaps in original Medicare — parts A and B — by paying for a portion of your deductible, coinsurance, and copayment costs. These supplemental plans help lower some of your out-of-pocket costs for services provided under Medicare.
There are 10 Medigap plans with different coverage and premiums to choose from depending on where you live. Medigap Plan M is one option to consider.
In this article, we’ll go over the 2021 costs for Plan M.
Regardless of where you live in the United States, every Plan M has the same level of coverage. However, costs can be different from state to state.
Medigap plans typically don’t have their own separate deductibles, copays, or coinsurance costs. You’ll have to pay a monthly plan premium.
With Plan M, you’ll also pay some of your Part A deductible and all of the Part B deductible. In addition, you are still responsible for your Part B premium, Part D medication costs, and other excess charges not covered by Medicare or Medigap.
Let’s take a closer look at the different costs associated with Plan M.
Premiums
All Medigap plans have a monthly premium in addition to your Part B monthly premium. Plan M premiums depend on where you live.
Medigap Plan M premium costs can be based on one of three main rules:
- Issue age rated. Rates are based on your age at the time of policy purchase. If you buy at a younger age, you’ll have a lower premium.
- Community rated. Premiums are the same for everyone, regardless of age.
- Attained age rated. Rates are based on current age and typically may go up as you get older.
Sample Part M costs for a 65-year-old male nonsmoker
| San Antonio, TX | Rochester, NY | Bellevue, WA | Flagstaff, AZ | |
|---|---|---|---|---|
| Plan M premium range (monthly) | $78– $248 | $250–$393 | $163 | $124–$253 |
Coinsurance, copays, and deductibles
In 2021, the Medicare Part A deductible is $1,484 per benefit period. Plan M covers half that expense. You’ll still have to pay 50 percent —$742 — out of pocket for inpatient hospital expenses.
Once you pay the Part B yearly deductible of $203, Medicare pays 80 percent of your covered outpatient expenses. Plan M pays the other 20 percent for covered expenses.
Only healthcare professionals who accept Medicare assignment (agrees to accept payment rates set by Medicare) will count as providing covered expenses.
If you visit a healthcare professional who doesn’t accept assignment, you’re responsible for any excess charges. It’s important to confirm that your healthcare professionals accept assignment or they could charge up to 15 percent above Medicare set rates.
You can search for Medicare-approved healthcare professionals here.
Plan M covers 100% of Part A hospital coinsurance and Part B coinsurance and copays.
Medigap Plan M covers the following costs:
- 100 percent of Medicare Part A hospital and coinsurance costs for an added 365 days after Medicare benefits run out
- 100 percent of Part A hospice coinsurance and copayment and skilled nursing facility coinsurance
- 50 percent of the Part A deductible
- 100 percent of Part B copayment and coinsurance
- first 3 pints blood transfusions after a medical procedure
- 80 percent of international covered travel medical costs
It’s also important to know what Part M doesn’t cover, such as:
- Part B deductible
- Part B excess charges
- prescription drugs
- dental, vision, hearing costs
- private nursing costs
You’re eligible to enroll in Plan M during open enrollment period if:
- you qualify for Medicare
- it’s available where you live
- you’re enrolled in Medicare Part A and Part B
Once you enroll in Part M, as long as you continue to pay your premiums, your plan cannot be cancelled regardless of your health status.
Medigap Plan M is sold through private insurance companies approved by Medicare. You may first buy Medigap Plan M during the 6-month open enrollment period, which starts the month you turn age 65, and after you enroll in Medicare Part B.
It’s easier to find coverage during this first open enrollment period, even if you have health problems. It can be more expensive outside this timeframe, and companies aren’t obligated to offer you coverage later.
You can visit the Medicare website and compare Medigap plans and coverage for your location. Enter your ZIP code, age, gender, and smoking status to see what plans are available and how much they’ll cost for you.
Since there are multiple private plan options, it’s important to shop around and compare prices.
- Medigap Plan M is a cost-sharing supplemental Medicare plan option for those who want some help with Part A and Part B out-of-pocket expenses.
- You still have to pay a portion of Part A and all of your Part B deductibles, along with any excess charges.
- Plan M may be suitable if you don’t expect too many medical expenses.
- You can visit Medicare plan comparison tool for more information on Medicare plans and costs in your area.
- You can also call 800-633-4227 to talk to an expert about plans and costs.