Medicare Part M: Coverage, Eligibility & Enrollment
Medicare Supplement Plan M (Medigap Plan M) is one of the newer of the 10 Medigap plans. It’s designed for people who want to pay a lower monthly rate (premium) in exchange for paying for half of the annual Part A (hospital) deductible and the full annual Part B (outpatient) deductible.
If you don’t expect frequent hospital visits and are comfortable with cost-sharing, Medicare Supplement Plan M may be a good choice for you.
Keep reading to learn more about this option: what it covers, who’s eligible, and when to enroll.
Medicare Supplement Plan M coverage includes:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: 100 percent
- Part A deductible: 50 percent
- Part A hospice care coinsurance or copayment: 100 percent
- blood (first 3 pints): 100 percent
- skilled nursing facility care coinsurance: 100 percent
- Part B coinsurance or copayment: 100 percent
- Part B deductible: not covered
- Part B excess charge: not covered
- foreign travel exchange: 80 percent
Cost-sharing is basically the amount of money due and payable by you after Medicare and your Medigap policies have paid their share.
You have original Medicare (parts A and B) and a Medigap Plan M policy. Following hip surgery, you spend two nights in the hospital, and then have a series of follow up visits with your surgeon.
Cost-sharing 1: Your surgery and hospital stay are covered by Medicare Part A after you have met the Part A deductible. Medigap Plan M pays half of that deductible and you are responsible to pay the other half out-of-pocket.
In 2020 the Medicare Part A inpatient hospital deductible is $1,408. Your Medigap Plan M policy share would be $704 and your share would be $704.
Cost-sharing 2: Your follow-up visits are covered by Medicare Part B and Your Medigap Plan M. Once you have paid for the annual Part B deductible, Medicare pays for 80% of your outpatient care and your Medicare Plan M pays for the other 20%.
In 2020 the Medicare Part B annual deductible is $198. You would be responsible for the full amount.
Out-of-pocket: Prior to picking your doctor, check to see if they will accept the Medicare assigned rates (price Medicare will approve for the procedure and treatment).
If your doctor does not accept Medicare’s assigned rates, you can either find another doctor who will or stay with your current doctor. If you elect to stay, your doctor is not allowed to charge more than 15 percent above the Medicare-approved amount.
The amount charged by your doctor above the Medicare assigned rates is called the Part B excess charge. With Medigap Plan M, you’re responsible for paying the Part B excess charges.
After you’ve received Medicare approved treatment at the Medicare-approved amount:
- Medicare Part A or B pays its share of the charges.
- Your Medigap policy pays its share of the charges.
- You pay your share of the charges (if any).
To be eligible for Medicare Supplement Plan M you must be enrolled in original Medicare Part A and Part B and live within the plan’s service area.
Your 6-month Medigap open enrollment period (OEP) is generally the best time to enroll in any Medigap policy including Medigap Plan M. Your Medigap OEP starts the month that you’re 65 or older and enrolled in Medicare Part B.
The reason to enroll during your OEP is that the private insurance companies that sell Medigap policies cannot deny you coverage and must offer you the best available rate, regardless of your health status. Best available rate may depend on factors, such as:
- marital status
- where you live
- whether you are a smoker
Enrolling outside your OEP may trigger a requirement for medical underwriting and your acceptance isn’t always guaranteed.
Medicare Supplement plans help cover some of the “gaps” between the cost of healthcare and what Medicare contributes to those costs.
With Medigap Plan M, you pay a lower premium but share in the costs of your Medicare Part A (hospital) deductible, Medicare Part B (outpatient) deductible, and Part B excess charges.
Before committing to Medigap Plan M or any other Medigap plan, review your needs with a licensed agent who specializes in Medicare supplements to help you. You can also contact your state’s State Health Insurance Program (SHIP) for free help in understanding available policies.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.