Understanding Medicare Supplement Plan M
Medicare Supplement Plan M is one of eight standardized Medicare Supplement Insurance plans that are available for purchase (in all states except for Massachusetts, Minnesota, and Wisconsin, as they have their own standardized Medicare Supplement plans). These plans are also known as Medigap since they fill in the coverage gaps left by Original Medicare Parts A and B. Medicare Supplement Plan M is sometimes referred to as the “shared deductible plan” and is one of the more popular supplement plans because it often has low monthly premiums with a decent amount of coverage.
What does Medicare Supplement Plan M cover?
Supplement Plan M covers 50% of your Original Medicare Part A deductible — the hospitalization deductible. In 2023, the deductible is $1,600 so you would be responsible for paying $800 toward annual out-of-pocket expenses for services including: inpatient hospital care, care in a skilled nursing facility, hospice care and some home health services. With Plan M, you are also responsible for paying the entire annual outpatient deductible.
Covered
Hospital Expenses: Once Original Medicare Part A benefits are used up, covers 100% of Original Medicare Part A coinsurance and hospital costs up to 365 days.
Hospital Expenses
Once Original Medicare Part A benefits are used up, covers 100% of Original Medicare Part A coinsurance and hospital costs up to 365 days.
Medical Expenses: Original Medicare Part B coinsurance or copayments.
Medical Expenses
Original Medicare Part B coinsurance or copayments.
Transfusions: First three pints of blood you receive in a medical procedure.
Transfusions
YFirst three pints of blood you receive in a medical procedure.
Hospice Care: Pays 100% Original Medicare Part A hospice care coinsurance or copayments.
Hospice Care
Pays 100% Original Medicare Part A hospice care coinsurance or copayments.
Skilled Nursing: Pays 100% of facility care coinsurance.
Skilled Nursing
Pays 100% of facility care coinsurance.
Additional Hospitalization Expenses: Pays 50% of the Original Medicare Part A deductible.
Additional Hospitalization Expenses
Pays 50% of the Original Medicare Part A deductible.
Foreign Travel Medical Emergencies: Pays 80% of foreign travel emergency medical coverage (up to plan limits).
Foreign Travel Medical Emergencies
Pays 80% of foreign travel emergency medical coverage (up to plan limits).
Not covered
Part B Deductible: The Medicare Part B deductible for 2023 is $226. After the deductible is met, you pay 20% of the Medicare-Approved Amount (this is the amount a doctor or supplier that accepts assignment can be paid in Original Medicare) for most doctor services, outpatient therapy and durable medical equipment.1
Part B Deductible
The Medicare Part B deductible for 2023 is $226. After the deductible is met, you pay 20% of the Medicare-Approved Amount (this is the amount a doctor or supplier that accepts assignment can be paid in Original Medicare) for most doctor services, outpatient therapy and durable medical equipment.1
Part B Excess Charges: Providers who don’t accept Medicare assignment may charge up to 15 percent more than what Medicare is willing to pay, known as Part B excess charges. Medicare assignment is the Medicare approved cost for a particular medical service. Medicare assignment is accepted by Medicare-approved providers.
Part B Excess Charges
Providers who don’t accept Medicare assignment may charge up to 15 percent more than what Medicare is willing to pay, known as Part B excess charges. Medicare assignment is the Medicare approved cost for a particular medical service. Medicare assignment is accepted by Medicare-approved providers.
Prescription Drugs: Medigap Plan M does not cover prescription drugs. However, you can buy an additional Medicare Prescription Drug plan to cover prescription drug costs.
Prescription Drugs
Medigap Plan M does not cover prescription drugs. However, you can buy an additional Medicare Prescription Drug plan to cover prescription drug costs.
Who can benefit from this type of supplement plan?
Supplement Plan M is often attractive to people who are in good health, those who don’t usually require hospital or skilled nursing care, and who are able to budget for potential unexpected medical emergencies.
Meet Ross, a Medicare Supplement Plan M User
Ross is a recently retired accountant and, no surprise, a numbers guy. So, when it came time to shop for a Medicare Supplement Plan, he had a strategy—identify a plan that offered good hospitalization benefits.
This was important to Ross because he has a history of hospitalizations related to his asthma. Now that he was going on Medicare, it was important to him to find a supplement plan that kicked in for 100% of hospital expenses once Original Medicare coverage was used up and also helped share the burden of paying his hospitalization deductible.
A world traveler, he also wanted peace of mind that he’d be covered if his asthma acted up when he was out of the country. If he could get a plan that also offered lower premiums, even better.
For these reasons, Ross chose Medicare Supplement Plan M.
Advantages to Medicare Plan M
- Reduced monthly premiums.
Drawbacks to Medicare Plan M
- It covers only 50% of your Original Medicare Part A deductible.
- You’ll be responsible for paying the entire annual outpatient deductible.
- No out-of-pocket limit.
Medicare Supplement Plan M Costs
Monthly premiums are set by the private insurance companies who offer Medicare Supplement Insurance and are based on age, health status, gender and various other factors. Depending on these factors including location, insurance companies may charge different premiums for the same Medicare Supplement Plan M.
That’s why it is in your best interest to shop around to ensure you are paying the lowest amount possible for your Medigap coverage. Companies may not cancel your coverage unless you don’t pay the plan premium, you weren’t truthful on the application, or the Medigap insurance company becomes bankrupt or insolvent.
With Plan M covering only 50% of your Medicare Part A deductible, you would be responsible for paying $800, as the deductible is $1,600 in 2023, toward your annual out-of-pocket expenses for services including: inpatient hospital care, care in a skilled nursing facility, hospice care and some home health services.
How Pricing Works For This Plan
Pricing for Medicare Supplement Plan M varies by company. Medigap policies can be priced in 3 ways: community-rated, issue-age-rated, and attained-age-rated.
- Community-rated: Generally, the same monthly premium is charged to everyone who has the Medigap plan, regardless of age. Premiums may go up because of inflation and other factors, but not because of your age.
- Issue-age-rated: The premium is based on the age you were when you bought the Medigap plan. Premiums are lowered for people who buy at a younger age and won’t change when you get older. Premiums may go up because of inflation and other factors, but not because of your age.
- Attained-age-rated: The premium is based on your current age, increasing your premium as you get older. Premiums are lower when you are younger, but continually increase as you age. Premiums may also increase because of inflation or other factors.2
When to Enroll in Medicare Supplement Plans
When you’re first eligible: The best time to enroll in a Medicare Supplement plan is when you’re first eligible, which is on the first day of the month in which you turn 65. This enrollment period is known as your Medigap Open Enrollment Period, which lasts for six months, and you must already be enrolled in Medicare Part A and B.
During this period, you can buy any Medigap policy sold in your state, regardless of any health issues or concerns, and you will generally see more favorable prices and more choices among Medigap policies during this period.
Outside open enrollment: While it’s often better to get coverage when you’re first eligible for Medigap, you can still apply for coverage after your initial enrollment period. If you apply for coverage after your initial enrollment period, though, there’s no guarantee an insurance company will sell you a policy if you don’t meet the medical underwriting requirements.
FAQs About Medicare Supplement Plan M
Learn more about Medicare Supplement Plan M with answers to frequently asked questions.
Do Medicare Supplement plans cover pre-existing conditions?
While insurance companies can’t make you wait for your coverage to start, they may make you wait for coverage for a pre-existing condition. Coverage for pre-existing conditions can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medicare Supplement plan.
After the 6-month period, the Medicare Supplement plan will cover the condition that was excluded. However, it is possible to avoid or shorten the waiting period for a pre-existing condition if you buy a Medicare Supplement plan during your Medigap open enrollment period to replace “creditable coverage” Medigap plan.3
How can I lower the costs of my Medigap Plan M?
While Medicare Supplement plans are standardized, meaning they offer the same benefits, the prices can be different between insurance companies. Shopping around is the best way to make sure you have the plan that you need at a price you can afford.
Do Medigap plans vary by state?
Medigap plans are standardized, meaning they offer the same benefits, across most of the states, except for Wisconsin Medicare Supplement Plans, Minnesota Medicare Supplement Plans, and Massachusetts Supplement Plans.
Compare Medicare Supplement Plans
Whether you are unable to enroll in Plan M or not sure if it’s the right plan for you, there are a variety of other Medicare Supplement plans. Learn more about other standardized Medicare Supplement plans below.
Find the Right Medicare Supplement Plan For You With SelectQuote
It’s normal to feel overwhelmed by all of your options with Medicare. At SelectQuote, we’ll walk you step-by-step through the comparing and shopping process to find the right Medicare Supplement plan for you.
