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 Medigap plans, each identified by a letter. Medigap plans aim to cover some of the out-of-pocket costs associated with parts A and B.
This article looks at the details of Medicare supplement insurance Plan M, the coverage it provides, applicable exclusions, and more.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare 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
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 plans cover 50% of the Part A deductible when it is for eligible medical expenses.
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.
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.