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Medigap Plan M

In most states, there are 10 standardized Medigap plans available, ranging from Plan A to Plan N. Each plan has its own specific coverage for services, out-of-pocket limits, and premium costs. Plan M provides additional coverage to Original Medicare at a relatively low monthly premium, making it an ideal choice for Medicare beneficiaries who can afford to pay some out-of-pocket expenses for their healthcare.

Medigap Plan M Coverage Benefits

Medigap Plan M is a cost-sharing policy that offers more comprehensive benefits compared to other available cost-sharing plans. The only cost-sharing requirement for this plan is for the Part A deductible, where members are responsible for paying 50% of the Part A inpatient deductible. With Plan M, members will have all of their coinsurance and copays for Medicare Part B covered, as well as Part A inpatient coverage for up to 365 days after the Part A benefits have been exhausted. However, it’s worth noting that Plan M does not cover the Part B deductible or Part B excess charges, which are not allowed in some states and are generally uncommon even in states that permit them.

Medigap Plan M Covers:

  • Part A coinsurance and up to an additional 365 days of hospital costs after Medicare benefits are exhausted
  • Part B coinsurance/copayment
  • Blood (3 pints)
  • Part A hospice coinsurance/copayment
  • Skilled nursing facility care coinsurance
  • 50% of the Part A deductible
  • 80% of foreign travel exchange
  • No out-of-pocket limit

What Medicare Supplement Plan M Doesn't Cover

  • Part B deductible
  • Prescription drugs.
  • Long-term care (like non-skilled care you get in a nursing home).
  • Dental care.
  • Vision care.
  • Private-duty nursing.

Individuals Who Benefit from Plan M

Medigap Plan M is a suitable choice for those who desire additional coverage beyond Original Medicare and are willing to pay 50% of hospital costs. It’s also a great option for those who like to travel outside the United States occasionally and want a plan with a lower monthly premium. Similarly, Plan D is a good option for individuals who are looking for comprehensive coverage for their medical expenses, including coverage for foreign travel emergencies, while still maintaining a lower monthly premium.

Medigap Plan M Premiums

The cost of Medigap Plan M premiums can vary depending on several factors, such as the individual’s location, age, gender, and tobacco use, as well as the insurance carrier. On average, the monthly cost for Plan M ranges from $120 to $2000. Generally, Plan M premiums are higher in states with a higher cost of living.

Plan M & Prescription Drug Coverage

Medigap Plan M covers prescription drugs that are administered during inpatient care, but it does not cover prescription drugs that are prescribed by a doctor and administered at home. To get prescription drug coverage for medications administered at home, Medigap plan members will need to enroll in a stand-alone Part D plan.

The Best Alternative to Plan M

There are a variety of options to consider as an alternative to Medigap Plan M, depending on an individual’s budget and coverage needs. Plans F and G provide more comprehensive coverage, but come with higher premiums. Meanwhile, the cost-sharing Plans K and L offer less coverage than Plan M, but have lower monthly premiums. It’s important to compare the benefits and costs of each plan to determine which one is the best fit for your needs and budget.

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