Medigap Plan M: Does It Make Sense for You?

Understanding the complexities of Medicare can feel challenging, but it’s crucial to master as you enter your golden years. As you explore options for supplementing your Original Medicare coverage, you’ll likely come across Medigap Plan M.

But what exactly is Medigap Plan M, and is it the right choice for you? This detailed guide will break down everything you need to know about this popular Medicare Supplement option, empowering you to make informed decisions about your healthcare.

Understanding the Basics of Medigap Plan M

Original Medicare, comprised of Part A (hospital insurance) and Part B (medical insurance), forms the foundation of coverage for millions of Americans aged 65 and over. However, Original Medicare isn’t designed to cover all medical expenses, leaving you responsible for deductibles, copayments, and coinsurance.

This is where Medicare Supplements, also known as Medigap, step in. Sold by private insurance companies, Medigap plans are designed to bridge the gap by covering some of these “extra” costs. Think of it as adding extra protection to your financial well-being regarding medical bills.

Like all Medigap plans, Plan M follows specific guidelines set by the federal government, ensuring that its benefits remain the same regardless of which insurance company you choose. The premiums each company charges differ, so shopping around is essential to finding a plan that fits your budget and provides you with the coverage you need. Remember, not all insurance companies offer Medigap.

Medigap Plan M Coverage: Striking a Balance

So, what exactly does Plan M cover? The plan is popular because it balances coverage and cost well. Here’s a closer look at its key benefits:

What Plan M Covers:

Part A Coinsurance and Hospital Costs: Plan M covers 100% of your Part A coinsurance. It also provides coverage for an additional 365 lifetime reserve days of inpatient hospital care after your Medicare benefits are exhausted. This means extended hospital stays won’t leave you with overwhelming medical debt.
Part B Coinsurance or Copayment: Plan M covers 100% of the Part B coinsurance or copayment for covered services. This benefit applies after you meet your Part B deductible.
Blood: You’ll have 100% coverage for the first 3 pints of blood needed each year.
Part A Hospice Care Coinsurance or Copayment: Plan M covers 100% of your hospice care coinsurance or copayments. This provides peace of mind for end-of-life care expenses.
Skilled Nursing Facility Care Coinsurance: Plan M provides 100% coverage for its associated coinsurance if you need skilled nursing care.
Foreign Travel Exchange: When traveling outside the United States, this plan covers 80% of eligible emergency medical costs, subject to a lifetime limit.

What Plan M Does Not Cover

This plan, however, doesn’t cover everything. To fully grasp your potential out-of-pocket costs, here are some things Plan M does not cover:

Part A Deductible: You are responsible for 50% of the Medicare Part A deductible, which was $1,556 in 2022.
Part B Deductible: You are responsible for 100% of your Part B deductible, which was $233 in 2022.
Part B Excess Charges: Unlike other plans, Plan M doesn’t offer coverage for Part B excess charges. These charges can arise when you see a doctor or utilize a provider who doesn’t accept Medicare assignment—meaning they don’t agree to Medicare’s approved amount for their services.

How Much Does Medigap Plan M Cost?

You are probably wondering how much Plan M costs. As with most insurance plans, multiple factors influence your monthly premium. Some factors affecting plan costs are where you live, your age, smoking status, gender, and even your health status, depending on your state rules.

To save money on Medicare, consider one of the cheap Medicare Supplements available. However, more affordable plans may come with higher out-of-pocket costs in the long run.

Finding a balance between monthly premiums and potential out-of-pocket expenses is key to choosing the right Medigap plan. We can help you compare Medigap plans in minutes.

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Weighing the Pros and Cons of Plan M

Like any insurance policy, it is essential to understand the advantages and drawbacks of enrolling in a particular Medigap plan to find the right one for you. Below is a breakdown of potential pros and cons to help with your decision.

You can learn more about some disadvantages of Medicare Supplement plans here.

Advantages:

Balanced Coverage: Plan M offers a compelling blend of coverage, addressing significant healthcare costs like Part A and Part B coinsurance, blood transfusions, skilled nursing facility care, and foreign travel emergencies. This level of coverage makes Plan M an attractive choice for people who are comfortable paying for a portion of their Part A deductible in exchange for more predictable healthcare expenses.
Lower Premiums than Some Plans: Compared to comprehensive plans such as Medigap Plan G (explore the pros and cons of Medicare Plan G here) or Plan N (Medicare Plan N Benefits can be reviewed here), Plan M generally has lower monthly premiums. This cost-saving feature can make a substantial difference in your monthly budget.
Predictable Costs: With Plan M, your maximum annual healthcare expenses are more predictable. Knowing you have coverage for most major healthcare costs can provide financial peace of mind.

Disadvantages

Part A Deductible: One key drawback is you’ll still be responsible for a portion of the Medicare Part A deductible. This contrasts with Plans G and N, which fully cover this expense. You must budget for potential hospital costs incurred until your deductible is met. Comparing Medigap plan coverage side-by-side may be worthwhile to determine which is best for your needs and budget.
Part B Deductible and Excess Charges: Similar to the Part A deductible, with Plan M, you’re also fully responsible for the Part B deductible and any extra charges. These costs can add up, especially if you require frequent doctor visits or specialized medical care.
Not Suitable for Frequent Hospital Users: For people with chronic conditions requiring frequent hospitalizations, the uncovered Part A deductible and lack of protection against extra charges may outweigh the advantage of lower premiums. If you anticipate needing significant hospital care, a plan like Plan G, which covers these costs, might be a better fit.

Is Medigap Plan M the Right Fit for You?

Determining if Plan M is the right fit hinges on your needs, health status, and financial considerations. This plan is often favored by those seeking a good balance of comprehensive coverage and affordable premiums and willing to take on a share of their medical costs in the form of the Part A deductible and possible extra charges.

Here’s a scenario to illustrate when Plan M could be a good option:

Imagine you’re relatively healthy, rarely needing to visit the hospital, and looking for ways to make your healthcare costs predictable. Plan M could provide this security. You’d have coverage for significant expenses such as hospital stays beyond what Medicare covers and skilled nursing care while benefiting from comparatively lower monthly premiums compared to more comprehensive plans.

Medicare Supplement Insurance provides valuable coverage; however, you can also be denied coverage, and we encourage you to learn more about the denial of Medicare supplement insurance. Use our online tool to compare all Medicare Supplement plans in your area, or get our free report and let us do the work.

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FAQs about Medigap Plan M

What does Medicare Part M cover?

“Medicare Part M” doesn’t actually exist, so it’s important not to confuse the term. “Medicare Part M” is often used mistakenly when referring to “Medicare Supplement Plan M,” commonly called “Medigap Plan M.”

What Medigap Plan Is Most Popular?

According to an AHIP report, Medicare Supplement Plans F and G are the two most popular Medigap plans nationally. They consistently hold the top spots, with Plan G surpassing Plan F for new enrollments. While Plan M may not be as widely held as Plan F or Plan G, its popularity is steadily rising due to the increasing cost of healthcare and Medicare. People often compare Medicare Plan N vs. Plan G: Which Supplement is best for you?

What are the disadvantages of a Medigap Plan?

Although Medicare supplement plans provide excellent secondary coverage for Original Medicare, you’ll find some disadvantages, such as weighing the disadvantages of Medicare Supplement Insurance. Although Medicare Supplement insurance plans help to pay some out-of-pocket expenses for medical costs, these plans do not provide coverage for everything, nor do they cover additional benefits such as vision, hearing, or dental.

Most Medigap plans also do not provide prescription drug coverage, so you’d want to explore options for a Medicare Part D Plan; however, not all companies offer Medigap. Additionally, Medigap plans can be expensive. For this reason, many people explore Medicare Advantage plans and wonder which one is more affordable. When exploring your Medicare options, getting quotes from several reputable insurance companies is a great idea to understand out-of-pocket costs.

What Is Medigap Plan N?

Medigap Plan N is another Medicare Supplement plan private insurance companies offer to Original Medicare (Part A and B) beneficiaries. Like Plan M, it has a few shared costs.

Conclusion

Medigap Plan M stands out as a Medicare Supplement option offering a blend of coverage and cost savings. By understanding what it covers, how it works, and considering its benefits and drawbacks, you can decide whether Plan M aligns with your health needs and financial preferences as you navigate the Medicare landscape.