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:

BenefitCoverage amount
Part A coinsurance and hospital costs, up to an additional 365 days after Medicare benefits are used up100%
Part A deductible50%
Part A hospice care coinsurance or copayment100%
Blood (first 3 pints)100%
Skilled nursing facility care coinsurance100%
Part B coinsurance and copayment100%
Foreign travel exchange80%

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.

Prescription drugs

Medicare Supplement Plan M doesn’t cover outpatient prescription drug coverage.

Once you have original Medicare (Part A and Part B), you can purchase Part D from a private insurance company. Part D is an add-on to original Medicare that offers 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.

Extra benefits

Medicare Supplement Plan M doesn’t cover vision, dental, or hearing. If that coverage is important to you, you might want to consider a Medicare Advantage (Part C) plan.

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.

Medigap policies are standardized plans available from private insurance companies. They help cover costs not paid for by Medicare Part A (hospital insurance) and Part B (medical insurance).

Choices

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.

Standardization

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.

Eligibility

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.

Payment

After getting Medicare-approved treatment at the Medicare-approved amount:

  1. Medicare Part A or B will pay its share of the cost.
  2. Your Medigap policy will pay its share of the cost.
  3. 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.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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