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Medigap Plan M

Medigap Plan M is a cost-sharing Medicare Supplement plan. It is a relatively unpopular Medigap plan, with on average less than 0.5% of Medigap enrollees choosing the policy. 

What does Medigap Plan M cover?

If you enroll in Medigap Plan M, you will receive 100% coverage for

  • Part A coinsurance payments for inpatient hospital care up to an additional year after your Medicare benefits have been expended
  • Skilled Nursing Facility (SNF) and Part A Hospice Care coinsurance and copays
  • Part B coinsurance and copays
  • Part B preventive care coinsurance 
  • First three pints of blood for a medical procedure 
  • Foreign travel emergency expenses (up to your plan’s limit)

Additionally, your Medigap plan will cover 50% of the following expenses

  • Part A deductible ($1,484 in 2021)

The only expenses that aren’t covered at all by Plan M are your Part B deductible and Part B excess charges* (which is also the case for Plan K and Plan L). 

*Excess charges are incurred when a medical provider doesn’t “accept assignment” or, in other words, charges more than the Medicare-approved amount that corresponds to their services.

Plan M Cost-Sharing

Because it is a cost-sharing plan, Plan M allows you to pay a lower monthly premium while receiving the majority of benefits offered by Medigap policies. 

But unlike the other cost-sharing plans, Plan K and Plan L, Plan M does not have an out-of-pocket maximum. This means that your out-of-pocket costs have no yearly limit. Plan M only partially covers (50%) your Part A deductible, and it is important to understand how this deductible works.

The Part A deductible resets each benefit period. And 60 days after being discharged from the hospital, your benefit period resets. 

So in the case of Plan M, if you visit the hospital after those 60 days have passed, you will once again be responsible for covering half of your Part A deductible. The Part A deductible has been set at $1,484 in 2021.

As you can see, unexpected hospital stays can end up costing you a significant amount of money over the course of one year. That’s why it is so important to understand the details of any given plan and why we always recommend consulting an experienced insurance agent before deciding on a Medigap plan. Reach out to us here at Medicare Plans Direct so we can help guide you through your Medigap plan selection process.

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