When you become eligible to enroll in Original Medicare — Medicare Parts A and B — you have many choices to make. While Medicare Part A and B can cover many of your healthcare needs, they do not cover everything. You can purchase Medicare Part C, also called Medicare Advantage, or select one of the ten Medicare Supplement plans.

Medigap policies are standardized across the US by letters and must be clearly identified as “Medicare Supplement Insurance.” In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. These plans are called Medigap because they fill in many gaps not covered by Original Medicare. 

What is Medigap Plan M? 

There are ten Medicare Supplement plans, each offering different coverage amounts. Medicare Supplement Plan M may have a lower premium than other Medigap plans because it only covers 50 percent of your Medicare Part A (hospital insurance) deductible. In 2024, the deductible for Part A will be $1,632. The Part A deductible can change each year, and in 2024 will go up $32 from the deductible cost in 2023.  

Medicare Supplement Plan M may have a lower premium than other Medigap plans because it only covers 50% of your Medicare Part A deductible.

Medicare Supplement Plan M coverage 

Medigap Plan M provides other benefits in addition to half of the Part A deductible to recipients, including: 

  • Part A hospital costs and coinsurance for up to 365 days after your Medicare benefits are used up; 
  • Part A hospice care copayment or coinsurance; 
  • Up to three pints of blood during a transfusion;
  • Part B copayment or coinsurance; 
  • Skilled nursing facility care coinsurance; 
  • Eighty percent of your medically necessary emergency care when traveling outside of the US for the first 60 days, with some limitations and after paying the deductible. 

Like the other Medicare Supplement plans, there are some things that Medigap Plan M does not cover, such as: 

Since 2020, insurance providers cannot sell Medigap policies including Part B deductible coverage unless the person qualified for Original Medicare before 2020 or purchased Plans C or F before 2020.  

How much does Medigap Plan M cost?  

Private insurers determine the premiums for each Medicare Supplement plan they offer, and premiums can vary significantly. Insurers can base their pricing on the initial age of the policyholder when they first purchase a policy. Or, the insurer could sell a policy with a premium that increases as the age of the policyholder increases. Finally, some insurers offer pricing not based on age but on factors in other issues like inflation or community trends. 

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But some costs will be the same regardless of the insurance company from which you buy your Medigap plan. Since Medigap Plan M only pays half of the Medicare Part A deductible, you will have to pay the other half. In 2024, the Part A deductible will be $1,632, so your portion would be $816. In addition, Plan M does not cover the Part B deductible, which is $240 in 2024. These deductibles can go up or down each year, depending on projections the Social Security Administration makes regarding healthcare costs. 

Medigap Plan M vs. N 

Each Medigap Plan type offers a different way to share the cost of healthcare. Medicare Supplement Plans M and N have many similarities. However, Plan N offers 100 percent coverage of the Medicare Part A deductible, compared to Plan M’s 50 percent. However, people with Plan N may have to pay more out-of-pocket for doctor visits and visits to the emergency room that do not result in inpatient admission. Under Plan N, policyholders could pay up to a $20 copay for doctor visits and up to $50 for emergency room visits that don’t end in admission. Policyholders of Plan M do not have to pay a copay for doctor’s office or emergency room visits.  

Is Plan M a good choice? 

It is vital to do careful research. Like other Medigap plans, Plan M does not cover dental, hearing, vision, or most prescription drugs. In addition, Plan M policyholders must pay half of their Part A deductible for each eligible period. When selecting a Medigap plan, it is essential to consider your current health and health changes that could occur in the future. Many people choose Plan M because it can offer lower premiums and because they do not expect to be hospitalized frequently. 

Questions about Medicare?

Shoot us an email at medicare@hihella.com.

Article updated on October 16th, 2023.

•November 16, 2022