Medicare Supplement (Medigap) Plan M

What is Medicare Supplement Plan M?

Medigap Plan M offers good coverage for healthy people who are unlikely to incur excess charges or require hospitalization. Although the coverage is similar, Plan M is not as popular as Medicare Plan N due to its typical premiums, which tend to run a bit higher. (For a complete overview of Medicare supplement insurance, see our Medigap plan comparison page.)

A Medicare Plan M policy covers the following Medicare Part A and Part B costs:

1. Medicare Part A hospital coinsurance and hospital costs up to a year after Original Medicare benefits are used up
2. Part A hospice care coinsurance and copayments
3. Medicare Part B copayments and coinsurance
4. First three pints of blood for a medical procedure
5. Skilled Nursing Facility care coinsurance
6. Medicare Part A deductible (at 50%)
7. Foreign travel emergency coverage (80% of approved costs up to plan limits)

Two costs that Plan M does not cover are the Medicare Part B deductible and Part B excess charges. Excess charges are an amount that a doctor or physician can charge (up to 15%) more than the Medicare-approved amount for a visit or service.

You can get a better idea of how Plan M stacks up with other plans with this Medicare Supplement Plan Comparison Chart:

Medicare Supplement Plan M Costs Explained

Supplemental Medicare insurance is available through dozens of private insurance companies. Each insurer is free to set their monthly premiums based on three common rating systems:

• Community-rated
• Issue-age-rated
• Attained-age-rated

Even though Medicare supplement benefits are standardized, carriers take many factors into consideration when setting premiums, including age, gender, location, use of tobacco products, and health status. As a result, Plan M premiums will vary, but the basic benefits will remain the same.

Also, you can rest assured that your Medigap policy can’t be cancel because you make claims or because the insurer no longer likes your health status. The only reasons you can be canceled are:

1. If you don’t pay your monthly premium,
2. If you move out of the plan’s area,
3. If you gave false information on your application, or
4. If the carrier goes out of business (bankrupt).

The Best Time to Enroll in Medicare Plan M

If you decide that Medicare Supplement Plan M is the best plan for you, it’s best to get enrolled during your personal Medigap Open Enrollment Period (OEP). This is a six-month window that begins on the first day of the month that you’re both age 65 or older and enrolled in Medicare Part B.

This is an important time because you have a special privilege. During your OEP you have a guaranteed-issue right to buy a Medigap Plan M policy, from the insurance company you choose, regardless of your health status. By law, you can’t be turned down and you can’t be charged a higher premium than a healthy person. However, you must be enrolled in both Medicare Part A and Part B, and you must live in the carrier’s service area.

Once your Open Enrollment Period is over, you may still apply for coverage, but insurance carriers can and will ask you to answer health questions. They will evaluate your answers using a medical underwriting process. If they don’t like your answers they don’t have to sell you a policy, or they can set certain conditions or charge you more.

Not all Medigap insurance companies offer Medigap Plan M. If you think Plan M might be right for you, ask your agent to show you rates from the carriers that do offer it. If you don’t have an agent, call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation, and they offer more plan options than any other national agency.