Medicare Supplement Insurance Plan M is one of 10 different standardized Medigap plan types. Learn about Plan M benefits and costs.
Medicare Supplement Insurance, also called Medigap, is a type of private insurance that is used together with your Original Medicare coverage (Medicare Part A and Part B) to help cover certain Medicare out-of-pocket expenses, such as copays and deductibles.
Medigap Plan M is one of the 10 Medigap plans available in most states, which include Plan A, B, C, D, F, G, K, L, M and N. Each type of Medigap plan offers a different combination of standardized benefits.
Let’s take a look at what Medicare Supplement Insurance Plan M covers and review the average cost of Medigap Plan M.
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* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020,... you may still be able to enroll in Plan F or Plan C as long as they are available in your area.
1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,490 in 2022. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
2 Plan K has an out-of-pocket yearly limit of $6,620 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3 Plan L has an out-of-pocket yearly limit of $3,310 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.+ Read more
Medicare Supplement Insurance Plan M provides 100 percent coverage for each of the following five benefit areas:
Medicare Part A coinsurance and hospital costs
If you are admitted to a hospital for inpatient treatment, Medicare Part A helps cover your hospital costs once you reach your Medicare Part A deductible, which is $1,556 per benefit period in 2022.
For the first 60 days of your hospital stay, you aren’t required to pay any Part A coinsurance.
But beginning on day 61 of your stay, you’re required to make a Medicare Part A coinsurance payment of $389 per day through day 90. After your 90th day in the hospital, you must pay $778 per day for up to 60 more days. Beyond that, you are responsible for all costs.
These coinsurance costs can add up quickly. Medigap Plan M covers 100 percent of your Part A coinsurance costs.
Medicare Part B coinsurance or copayment
Medicare Part B helps cover costs for things like doctor’s appointments, medical devices and preventive care.
After you meet your Medicare Part B deductible (which is $233 per year in 2022), you are typically responsible for a coinsurance or copay of 20 percent of the Medicare-approved amount for covered services.
For example, if you suffer a foot injury and need to use a wheelchair, Part B will help cover 80 percent of the cost of your wheelchair (after you meet your Part B deductible). For illustration purposes, if it costs $800 to buy the wheelchair and Medicare Part B covers it as durable medical equipment (DME), your Part B coinsurance cost would be $160.
Medigap Plan M would fully cover your $160 Part B coinsurance.
First three pints of blood
Original Medicare does not cover the cost of the first three pints of blood you might need for a blood transfusion. A pint of blood can potentially cost hundreds of dollars.2
Medicare Supplement Insurance Plan M covers 100 percent of the cost for your first three pints of blood.
Part A hospice care coinsurance or copayment
Medicare Part A requires a copayment for prescription drugs used during hospice care. You might also be charged a 5 percent coinsurance for inpatient respite care costs.
Medigap Plan M covers 100 percent of your Medicare Part A hospice care coinsurance or copayments.
Skilled nursing facility care coinsurance
Medicare Part A requires a coinsurance payment of $194.50 per day in 2022 for inpatient skilled nursing facility stays longer than 20 days. You are responsible for all costs after day 101 of an inpatient skilled nursing facility stay.
Medigap Plan M covers 100 percent of your skilled nursing facility care coinsurance costs.
Medicare Supplement Plan M provides partial coverage for the following two benefits:
Medicare Part A deductible
As mentioned above, the Medicare Part A deductible is $1,556 per benefit period in 2022.
The Medicare Part A deductible is not annual — you could potentially need to meet this deductible more than once in a given year.
Medigap Plan M covers 50 percent of the Medicare Part A deductible.
Foreign travel emergency care
In most cases, Original Medicare does not provide coverage for emergency medical care received outside of the U.S.
Medigap Plan M covers 80 percent of emergency medical care received abroad.
What you need to know about Medigap Plan M
There are a few things to know about Medicare Supplement Insurance Plan M, beyond what it covers.
Medigap plans and Medicare Advantage plans are very different things. You cannot have a Medicare Supplement Insurance (Medigap) plan and a Medicare Advantage plan at the same time.
Medicare Advantage plans provide all the same benefits as Original Medicare. Many Medicare Advantage plans also offer benefits that Original Medicare doesn’t cover, such as coverage for prescription drugs, dental, vision, hearing and more.
Medicare Supplement Insurance does not offer any medical benefits or coverage for prescription drugs and other services. Medigap plans only cover certain Medicare Part A and Part B out-of-pocket costs as outlined above.
Medicare Supplement Insurance Plan M doesn’t cover everything
Medicare Supplement Insurance Plan M does not offer any coverage for the following Medicare costs:
Other Medicare Supplement Insurance plans may cover some or all of the benefits listed above, either partially or in full. Medicare Supplement Insurance Plan F, for example, covers all of them.
Learn More About Medicare Supplement Insurance
Medicare Supplement Insurance Plan M may or may not be right for your health care needs. Research all of the plans available where you live and speak with a licensed insurance agent to evaluate your needs.
1 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.
2 Fisher, Miles. Your blood could be worth a lot. You should give it away for free. (July 5, 2017). Chicago Tribune. Retrieved from www.chicagotribune.com/news/opinion/commentary/ct-blood-donation-money-20170705-story.html.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
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