Medicare

What is Medigap Plan M?

Medigap Plan M covers out-of-pocket expenses, such as copays and deductibles for Medicare Part A and B. Read on to learn how Medigap coverage works, the best time to enroll, and what Medicare Plan M does and doesn’t cover.

Medicare Plan M

Medigap or Medicare Supplement Insurance fills the gaps in your Medicare coverage. If you have Medicare Part A and Part B (Original Medicare) and receive medical care, you will pay out-of-pocket costs such as copays and deductibles. A Medigap plan helps cover what you owe after your insurance pays. Most states have ten Medigap plans, each offering different benefits. We’ll discuss Plan M below.

How Medigap Plan M Works

A Medicare Supplement Plan is private insurance used with Original Medicare to pay expenses, such as deductibles and copays. For example, your deductible in 2022 is $1,556 per benefit period if you have a hospital stay. After you pay that, Medicare Part A pays for your inpatient treatment. A Medicare Supplement plan covers all or part of your deductible, depending on your chosen plan.

Funded by the federal government, Original Medicare comprises Part A, hospital coverage, and Part B, medical services. Prescription drug coverage is not included, though you can join Part D, a Medicare Drug Plan. Original Medicare doesn’t cover other benefits, including vision, hearing, and dental services.

Medicare Advantage is another type of coverage offered by private insurance companies, following Medicare guidelines. Most Medicare Advantage plans bundle drug coverage and vision care with Parts A and B. They typically have a yearly limit on your out-of-pocket expenses. You can’t buy a Medigap plan with Medicare Advantage insurance.

There are 10 Medigap plans with standardized benefits in most states. They are Medigap Plan A, B, C, D, F, G, K, L, M, and N. Three states, Massachusetts, Minnesota, and Wisconsin, offer plans with different benefits. Below are facts about Medicare Supplement Insurance Plan M.

What Medicare Supplement Plan M Covers

If you’ve selected Medicare Supplement Plan M, it covers your costs after insurance pays the provider.

Plan M covers copayments and coinsurance for hospital or hospice care, doctor visits, or skilled nursing care. A copayment is a set amount you pay when you receive care, such as $20 for seeing the doctor. The coinsurance payment is the percent of the cost you pay for your care after paying your deductible. If your coinsurance is 20%, and your medical bill is $100, you pay $20 or 20% of the bill after your deductible is paid. 

It also covers half of your hospital deductible. If you need inpatient care in a hospital or skilled nursing facility, your Medicare Part A coverage is $1,556 per benefit period in 2022. The benefit period starts the day you are admitted to a hospital and ends when you haven’t received care for 60 days.

Other health services Plan M covers include:

  • The first 3 pints of blood if you require transfusions.
  • Foreign travel emergency care during the first 60 days of your trip.
  • 80% of emergency care outside the U.S. after a $250 deductible

What Medicare Supplement Plan M Does Not Cover

There are some health care services Medigap policies don’t cover. These include the Medicare Part B deductible and the Part B excess charge when a provider charges more than the amount approved by Medicare. Medigap won’t cover private-duty nursing, prescription drugs, long-term care, dental or vision services, or hearing aids.

Medicare Supplement Plan M Eligibility

Anyone eligible for Medicare is eligible for a Medicare Supplement Plan. Here are the requirements: 

  • Enrolled in Medicare Part A and Part B. 
  • Age 65 and older
  • Reside in the state offering the plan 
  • Enroll without underwriting during the initial enrollment period around your 65th birthday.
  • After the initial enrollment period, you will go through underwriting. You might not qualify for coverage or have to pay more if you have health conditions. 

Plan M vs. Other Medigap Options

Medigap Plan M pays the total cost after you’ve met the deductible for most of the services it covers. But unlike some of the other Medigap plans, Plan M only covers 50% of the Part A deductible. In 2022, that deductible is $1,566, so Plan M would cover half of that or $778. Plan M pays for 80% of emergency care during foreign travel if you get sick while traveling.

Most Medigap Plans, including Plan M, have no out-of-pocket limit. That’s the amount you pay before your Medicare Supplement Plan pays 100%. For example, Medigap Plan L has a $3,310 out-of-pocket limit in 2022. After paying that amount, someone with Plan L would have 100% of covered services paid for the remainder of the year. While Plan M does not have an out-of-pocket limit, its coverage of copays and coinsurance keeps your costs down.

How to Enroll in Medigap Plan M

In most cases, the best time to enroll in Medicare and a Medigap Plan is when you first become eligible around your 65th birthday.

Individual Initial Enrollment Period

The initial enrollment period for Medigap plans starts on the first day of the month you turn 65 and enroll in Part B, which totals six months. If you enroll in Part B in January, your enrollment period lasts through May. During this period, you can buy a Medicare Supplement plan without going through underwriting or having the insurer review your health history. You won’t be turned down or charged higher premiums due to pre-existing health conditions.

When you have health insurance coverage through your employer, your open enrollment period begins when you enroll in Medicare Part B after your group coverage ends. You will go through medical underwriting if you miss the open enrollment period. You could be declined coverage due to pre-existing conditions or charged a higher rate.

Medicare Open Enrollment Period

The initial enrollment period for Medicare begins three months before you turn 65 and ends three months after your 65th birthday. 

If you don’t enroll in Medicare during the initial enrollment period when you turn 65, you’ll have to wait until the Open Enrollment Period. This period occurs from October 15 – December 7 of each year. During this time, you can change plans, add Medicare Part D to cover prescription drugs or enroll in a Medigap plan. If you apply during the open enrollment period, coverage begins on January 1.

Special Enrollment Periods

In some situations, you can sign up for coverage outside the initial or open enrollment period. After a qualifying life event, you have a two-month special enrollment period to sign up for Medicare.

Qualifying life events include:

  • Losing your employer-based insurance
  • Moving out of your plan’s service area
  • Having your plan close or stop serving in your area
  • Moving into or out of a qualified facility like a nursing home
  • Gaining or losing eligibility for Medicare financial assistance such as Medicaid, Extra Help, or a Medicare Savings Program.

If you work past age 65 and have health insurance at work, an 8-month special enrollment period lets you enroll in Part A and Part B. You have two months to enroll in Part C, Medicare Advantage, and Part D, prescription drug coverage, without paying a late penalty.