What is Medicare Supplement Plan M?
Medigap Plan M offers good coverage for healthy people who are unlikely to incur excess chargesA Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment. or require hospitalization. Although the coverage is similar, Plan M is not as popular as Medicare Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... due to its typical premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , which tend to run a bit higher. (For a complete overview of Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., see our Medigap plan comparison page.)
A Medicare Plan M policy covers the following Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B costs:
- Medicare Part A hospital coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. and hospital costs up to a year after Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. benefits are used up
- Part A hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care coinsurance and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.
- Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. copayments and coinsurance
- First three pints of blood for a medical procedure
- Skilled Nursing Facility care coinsurance
- Medicare Part A deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. (at 50%)
- Foreign travel emergency coverage (80% of approved costs up to plan limits)
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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 amountA Medicare-approved amount is what Medicare will pay for a covered service. Healthcare providers that agree to Medicare assignment accept the approved amount without excess charges. What Does Medicare-Approved Amount Mean? A Medicare-approved amount is... 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:
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:
- If you don’t pay your monthly premium,
- If you move out of the plan’s area,
- If you gave false information on your application, or
- 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 PeriodUpon initial enrollment in Medicare Part A and Part B, beneficiaries have a one-time, six-month period to buy a Medicare supplement policy with guaranteed issue rights. This is the 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 rightGuaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting. 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 PeriodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31. 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.
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