Medicare Plan M is a supplementary insurance plan that works alongside original Medicare. As a supplement insurance plan, its aim is to cover some of the expenses that original Medicare does not.
Private insurance companies administer specific Medicare plans, such as Medicare Advantage and Medicare supplement plans.
Supplement plans are also known as Medigap policies and are a type of health insurance that works with original Medicare Part A and Part B.
There are currently ten standardized Medigap plans, each identified by a letter. These Medigap plans aim to fill the gaps in coverage that a person may have with Original Medicare. They can help cover some out-of-pocket costs, such as copayments, coinsurance, and deductibles.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare, which includes Part A and Part B, pays for most, but not all costs relating to health care services and supplies.
Medigap plans help fill some gaps in coverage left by original Medicare, such as deductibles and copayments.
The plans have standardized benefits that all policies must cover, including:
- hospital coinsurance
- 365 additional days of hospital care
- all or part of the 20% coinsurance for doctor charges and other Part B services, including preventive care
- all or part of the cost of the first three pints of blood a person may need per year
- hospice coinsurance
Medigap also has other benefits and a person may be covered for services such as:
- at-home recovery
- some preventive care not covered by Medicare
- coinsurance for a skilled nursing facility
- emergency health care provided outside the United States
Medicare Plan M is one of the ten Medigap plans currently available.
The Plan M benefits include 100% coverage for:
- hospital costs for up to an additional 365 days once the original Medicare benefit has been used
- Part A coinsurance
- Part A hospice care coinsurance or copayment
- Part B coinsurance or copayment
- the first 3 pints of blood a person may need
- skilled nursing facility care coinsurance
Plan M policies cover 80% of eligible medical costs when emergency care is needed outside of the U.S. This benefit is called foreign travel exchange and is available up to the plan limits.
Also, Medigap plan M covers 50% of the Part A deductible when it is for eligible medical expenses.
While Plan M polices and their coverage will not vary between private insurers, it is advisable to read the plan terms for precise conditions of how and where to use them.
Plan M does not cover the Part B deductible or the Part B excess charge.
Some healthcare providers are allowed to charge over the Medicare-approved amount for a service.
An excess charge is anything above a Medicare-approved amount.
Medigap plans costs can vary widely as different insurance companies charge different prices for the same or similar coverage.
A person may pay a monthly premium for Medigap coverage, and this charge is separate from the premium for original Medicare.
Each person also has a 7-month Initial Enrollment Period (IEP), which starts at the beginning of the month in which they turn 65.
This is usually a great time for a person to consider enrolling, as insurance companies will not take medical history into consideration.
A person can also enroll during the Open Enrollment Period (OEP) that runs from October 15 through December 7 every year.
Outside of those enrollment periods, it may not be possible for individuals to enroll in a Medigap plan, as many insurers do not offer policies outside of the enrollment windows.
Individuals must be enrolled in Medicare Part B to be eligible for a Medigap plan.
Some people may prefer different coverage options.
For example, although Plan M generally covers Part B coinsurance and copayments, it does not cover Part B deductibles or Part B excess charges that may be preferable for some individuals.
A person can compare the different Medigap policies online, or by contacting their local State Health Insurance Assistance Program (SHIP) at 877-839-2675.
To find a Medigap policy, the Medicare online plan finder tool is available for a person to explore options and find contact details for plan providers.
Plan C and Plan F discontinuation
Some Medigap plans are no longer available for those new to Medicare.
New Medicare enrollees cannot purchase the discontinued Plan C or Plan F.
If a person already has either plan, they may keep it.
It may also be possible to change to one of these plans if a person has been eligible for Medicare since before January 1, 2020.
Medigap and Medicare Advantage
It is not possible to have a Medigap plan alongside a Medicare Advantage plan.
It is illegal practice for anyone to sell a person a Medigap plan if they already have a Medicare Advantage policy, unless they are planning to change back to original Medicare.
What is Plan M in Medicare?
Medigap Plan M is a type of Medicare Supplement Insurance plan. Private insurance companies may offer Plan M to help cover some out-of-pocket costs associated with Original Medicare. It is similar to Medigap Plan D, but instead of covering the full Medicare Part A deductible like Plan D, Plan M only covers half.
What are the other Medigap Plans?
Medigap provides a number of plans with different benefits. These plans range from Plan A to Plan N. Each plan varies slightly with the benefits they provide, so a person should be able to find a plan that suits them best.
What does the M at the end of a Medicare number mean?
People can purchase extra insurance from private companies that help pay for costs in Original Medicare. These are lettered plans that range from Plan A to Plan N.
People may also notice that they have a letter following their Medicare number. This is known as a Social Security beneficiary code. In this case, the letter M denotes that a person is uninsured.
Medicare Plan M is a type of Medigap plan that works with original Medicare only.
The plans cover remaining medical and out-of-pocket costs that original Medicare may not cover. Typically covered items include coinsurance, copayments, and deductibles.
A person should consider signing up for Plan M during their IEP.
Medigap Plan M does not cover the Part B deductible or Part B excess charge.
A person is able to compare plans online or by contacting their local SHIP center.