Medicare Supplement Plan M (Medigap Plan M) was developed to offer a reduced monthly premium, which is the amount you pay for the plan. But in exchange, you’ll have to pay for your annual outpatient deductible and half of your hospital deductible.
Medigap Plan M is one of the offerings created by the Medicare Modernization Act, signed into law in 2003. Plan M was designed for people who are comfortable with occasional cost-sharing and don’t expect to need many future hospital visits.
Read on to learn what’s covered and what’s not covered under Medicare Plan M.
Medicare Supplement Plan M coverage includes:
|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 exchange||80%|
The following are not covered under Plan M:
- Part B deductible
- Part B excess charge
As mentioned, Medicare Supplement Plan M doesn’t cover your Part B deductible or Part B excess charge.
Plus, Medigap plans don’t include coverage for prescription drugs or for extra benefits, such as dental, vision, or hearing.
Medicare Supplement Plan M doesn’t cover outpatient prescription drug coverage.
Although providers are required to offer a standard level of coverage (set by Medicare) for Part D plans, they can vary in price and prescription drugs covered. Be sure to check your plan’s formulary — a list of medications the plan covers — to make sure that yours are included.
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 choose only 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.
You must first be enrolled in original Medicare in order 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. And know that, 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.
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