Medicare Supplement (Medigap) Plan M was developed to offer a low monthly premium, which is the amount you pay for the plan. In exchange, you’ll have to pay half of your Part A hospital deductible.
Medigap Plan M is one of the offerings created by the Medicare Modernization Act, which was signed into law in 2003. Plan M was designed for people who are comfortable with cost-sharing and don’t expect frequent hospital visits.
Read on to learn what’s covered and not covered under Medicare Supplement Plan M.
Medicare Supplement Plan M coverage includes the following:
|Part A coinsurance and hospital costs, up to an additional 365 days after Medicare benefits are used up||100%|
|Part A deductible||50%|
|Part A hospice care coinsurance or copayment||100%|
|blood (first 3 pints)||100%|
|skilled nursing facility care coinsurance||100%|
|Part B coinsurance and copayment||100%|
|foreign travel medical costs||80%|
The following benefits are not covered under Plan M:
- Part B deductible
- Part B excess charges
If your doctor charges a fee above the Medicare assigned rate, this is called a Part B excess charge. With Medigap Plan M, you’re responsible for paying these Part B excess charges.
In addition to these exceptions, there are a few other things that aren’t covered by any Medigap plan. We’ll explain those next.
Medigap isn’t legally allowed to offer outpatient prescription drug coverage.
Once you have original Medicare (Part A and Part B), you can purchase Medicare Part D from a private insurance company. Part D is an add-on to original Medicare that offers prescription drug coverage.
Medigap plans also do not cover vision, dental, or hearing care. If that coverage is important to you, you might want to consider Medicare Advantage (Part C), as these plans often include such benefits.
As with Medicare Part D, you purchase a Medicare Advantage plan from a private insurance company.
It’s important to know that you can’t have both a Medigap plan and a Medicare Advantage plan at the same time. You may only choose one or the other.
In most states, you can choose from among 10 different standardized Medigap plans (A, B, C, D, F, G, K, L, M, and N). Each plan has a different premium and features different coverage options. This gives you the flexibility to choose your coverage based on your budget and your healthcare needs.
If you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies — including the coverage offered through Medigap Plan M — are standardized differently than in other states and may have different names.
You must first be enrolled in original Medicare to be eligible for Medicare Plan M or any other Medigap plan.
Coverage for your spouse
Medigap plans cover only one person. If you and your spouse are both enrolled in original Medicare, you’ll each need your own Medigap policy.
In this case, you and your spouse can choose different plans. For example, you might have Medigap Plan M and your spouse might have Medigap Plan C.
After getting Medicare-approved treatment at the Medicare-approved amount:
- Medicare Part A or B will pay its share of the cost.
- Your Medigap policy will pay its share of the cost.
- You’ll pay your share, if any.
For example, if you have outpatient follow-up visits with your surgeon after a procedure and you have Medicare Supplement Plan M, you’ll pay for those visits until you’ve paid your annual Medicare Part B outpatient deductible.
After you’ve met the deductible, Medicare pays for 80 percent of your outpatient care. Then, Medicare Supplement Plan M pays for the other 20 percent.
If your surgeon doesn’t accept Medicare’s assigned rates, you’ll have to pay the overage, which is known as the Part B excess charge.
You can check with your doctor before receiving care. By law, your doctor isn’t allowed to charge more than 15 percent above the Medicare-approved amount.
Medicare Plan M can help you pay for medical expenses not covered under original Medicare (parts A and B). Like all Medigap plans, Medicare Supplement Plan M doesn’t cover prescription drugs or extra benefits, such as dental, vision, or hearing.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.