Medicare Supplement Plan M: Eligibility, Coverage, Cost, Benefits & How to Buy?

Let’s face it—navigating Medicare can feel a bit like trying to solve a puzzle where some pieces don’t quite fit. You know Medicare Part A and Part B help with a lot, but there’s still plenty they don’t cover. That's where Medicare Supplement plans, or Medigap, step in. And today, we're diving into one particular plan that’s great for those who want coverage but don't mind sharing a bit of the cost: Medicare Supplement Plan M. In this blog post, we’ll break down what Medicare Supplement Plan M covers, how it works, and whether it might be the right fit for you.

What is Medicare Supplement Plan M?

Medicare Supplement plans, also known as Medigap, are designed to fill the "gaps" in Original Medicare (Part A and Part B). These plans help pay for expenses such as copayments, coinsurance, and deductibles that Medicare does not cover.

Plan M is one of 10 standardized Medigap plans available in most states. It's a middle-of-the-road plan in terms of coverage and premium costs. One unique aspect of Plan M is that it offers 50% coverage for the Part A deductible while still covering most other out-of-pocket costs. It’s a great option for those who want more comprehensive protection than the basic Medigap plans but are willing to share some costs to keep their premiums lower.

What Does Medicare Supplement Plan M Cover?

Here’s a breakdown of the key features and what you can expect Plan M to cover:

Medicare Part A Coinsurance and Hospital Costs: Plan M covers the full coinsurance amount for hospital stays (beyond what Medicare pays) up to an additional 365 days after Medicare benefits are used up.
Medicare Part B Coinsurance or Copayments: It covers 100% of the coinsurance and copayments for doctor visits and outpatient care under Medicare Part B.
Blood: Plan M covers the first 3 pints of blood if you need a transfusion.
Skilled Nursing Facility Care Coinsurance: If you need skilled nursing care, Plan M covers the coinsurance for those services.
Foreign Travel Emergency: Should you require medical care while traveling abroad, Plan M covers 80% of the costs after a small deductible.

What Plan M Doesn't Cover?

However, there are a few costs you’ll still need to pay out of pocket:

Medicare Part A deductible: Plan M covers half of this. So, if you need to stay in the hospital, you’ll be responsible for paying 50% of the deductible, which is about $816 in 2024 (since the full deductible is $1,632).
Medicare Part B deductible: Plan M doesn’t cover this one. You’ll have to pay the full Part B deductible, which is $240 in 2024, before Medicare kicks in for your outpatient care.
Part B excess charges: If your doctor charges more than Medicare approves, those extra costs are on you.

Who is Eligible for Medicare Supplement Plan M?

To be eligible for Medicare Supplement Plan M, you must meet a few basic requirements:

1. You Must Be Enrolled in Medicare Part A and Part B:

Before you can sign up for any Medigap plan (including Plan M), you must be enrolled in both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). These two parts are the foundation of Medicare, and your Medigap plan steps in to fill in the gaps where Original Medicare leaves off.

Part A is often automatic and free if you’ve worked and paid Medicare taxes for at least 10 years.
Part B requires you to pay a monthly premium, and you must be actively enrolled in both Part A and B to be eligible for Plan M.

2. You Must Be 65 or Older (In Most Cases):

Most people become eligible for Medicare when they turn 65. At that point, you can also choose to purchase a Medigap plan like Plan M. If you’re nearing that milestone birthday, this is your chance to start thinking about what type of coverage best fits your needs.

Now, here’s a twist: Some people under 65 might be eligible for Medicare if they have certain disabilities or conditions like End-Stage Renal Disease (ESRD) or ALS. But, the tricky part is that not all states offer Medigap plans to people under 65, so if you fall into this category, you’ll need to check with your state to see what’s available.

3. You Must Enroll During Your Medigap Open Enrollment Period:

Here’s where timing really matters. You’ve got a 6-month window that starts the month you turn 65 and enroll in Medicare Part B. This is called your Medigap Open Enrollment Period, and it’s the best time to sign up for Medicare Supplement Plan M (or any Medigap plan).

Why is this period so important? Because during this time, you have guaranteed issue rights. That means insurance companies:

Can’t deny you coverage
Can’t charge you higher premiums based on your health history
Can’t make you wait for coverage because of pre-existing conditions

Once this window closes, things can get a little trickier. If you try to sign up outside of this enrollment period, insurers can deny you coverage or charge you more if you have certain health conditions.

4. Pre-Existing Conditions:

One of the advantages of signing up during your Medigap Open Enrollment Period is that you cannot be denied coverage for pre-existing conditions. However, if you enroll outside of this period, insurers might charge you higher premiums or even deny coverage based on your health history. However, if you miss this period and try to enroll later, they might be able to deny coverage based on your health or charge you higher premiums. So, the sooner you get enrolled, the better.

5. Residency Requirements:

Medigap plans are regulated by the state, which means you have to purchase your Medicare Supplement Plan M in the state where you live. Most states follow the same standardized rules, but a few (like Massachusetts, Minnesota, and Wisconsin) have slightly different setups. So, if you live in one of those states, just know that your plan may look a little different.

What Happens if You’re on Medicare Advantage?

If you’re currently on a Medicare Advantage Plan (Part C), you can’t enroll in a Medigap plan at the same time. Medigap only works with Original Medicare (Parts A and B), so you’d need to switch back to Original Medicare if you wanted to sign up for Plan M.

Medicare Supplement Plan M Cost

On average, monthly premiums for Medicare Supplement Plan M range from about $100 to $300. But the actual amount you’ll pay depends on where you live and the factors mentioned above. For example:

A 65-year-old in a lower-cost area might pay around $120 to $150 per month.
In a higher-cost region or for older beneficiaries, the premium could be closer to $250 to $300 per month.

Other Costs to Consider

It’s important to know that while Plan M has lower premiums than some other Medigap options, there are some costs you’ll share:

50% of the Medicare Part A deductible: Plan M only covers half of the $1,632 Part A deductible (as of 2024), so if you’re hospitalized, you’ll be responsible for about $816 out of pocket.
Full Medicare Part B deductible: Plan M doesn’t cover the Part B deductible, which in 2024 is $240. You’ll need to pay this cost upfront for things like doctor visits.
Potential excess charges: If your doctor charges more than Medicare’s approved amount (which some do), Plan M won’t cover those excess charges. So, you’ll need to budget for any amount over what Medicare typically pays.

How to Buy Medicare Supplement Plan M?

Choose the right time to enroll: Your best bet is to sign up during the Medigap Open Enrollment Period. This is the 6-month window that starts when you turn 65 and have Part B. During this time, insurers can’t deny you coverage or charge you more for pre-existing conditions.
Shop around for different insurers: Medicare Supplement Plan M is offered by private insurance companies, so it’s a good idea to compare prices. Even though the benefits are the same, premiums can vary depending on the company you choose.
Check availability in your state: Not all states offer Plan M, so make sure it’s available where you live before getting too far into the process.
Get quotes online or talk to an expert: You can easily get quotes from insurance company websites or reach out to a licensed agent. Agents can help guide you through the process and ensure you get the right plan for your needs.
Look for discounts: Some insurers offer household discounts if you and a spouse are signing up together. Be sure to ask about any potential savings.
Read the details carefully: Before finalizing your choice, double-check the fine print to ensure the plan covers what you need and that the monthly premium fits your budget.
Submit your application: Once you’ve chosen the best insurance provider, apply either online, over the phone, or with the help of an agent. If you're within your open enrollment period, you’ll be approved without any issues.
Pay your premium to start coverage: After your application is accepted, you’ll start paying your monthly premium to keep your Plan M coverage active.

Benefits of Medicare Supplement Plan M

Lower monthly premiums: Plan M is a great option if you're looking to keep your monthly costs down while still having solid coverage.
Covers hospital costs: It fully covers your Medicare Part A coinsurance, so you won’t have to worry about huge hospital bills if you’re admitted.
Foreign travel emergency coverage: If you’re someone who loves to travel, Plan M has your back by covering 80% of medical emergencies abroad.
Helps with recovery care: It offers coverage for skilled nursing facilities, which can be a relief if you need extra care after a hospital stay.
Full Part B coinsurance coverage: Plan M covers all of your Medicare Part B coinsurance, so visits to the doctor won’t leave you with unexpected costs.

Drawbacks of Medicare Supplement Plan M

You’ll pay part of the hospital deductible: Plan M only covers 50% of your Medicare Part A deductible, so if you’re hospitalized, you’ll still need to pay part of that bill out of pocket.
Full responsibility for Part B deductible: Unlike some other plans, Plan M doesn’t cover the Medicare Part B deductible, meaning you’ll have to pay that upfront.
No protection against excess charges: If your doctor charges more than what Medicare covers, you’ll have to pay the difference. Plan M won’t cover these extra costs.
Can be costly if you’re hospitalized often: Since it only covers half of the Part A deductible, frequent hospital stays could mean bigger bills for you.
Not available everywhere: Depending on where you live, Plan M might not be offered, so you’ll need to check if it’s available in your state.

How is Plan M Different from Other Plans?

There are a bunch of Medigap plans out there, and figuring out which one is best can be tricky. But here's how Plan M stands out:

It’s designed for people who are looking for affordable premiums but are willing to pay for a portion of their hospital costs if needed. For example, Plan F and Plan G are popular for offering full coverage on almost everything—including that hospital deductible—but they also come with higher monthly premiums.

Plan M, on the other hand, splits the difference. By sharing part of the hospital deductible, it keeps your premiums lower but still gives you solid coverage for doctor visits, blood transfusions, and even foreign travel emergencies.

Is Medicare Supplement Plan M Right for You?

Let’s be real: No one has a crystal ball when it comes to their health. But if you’re someone who generally stays healthy and doesn’t anticipate frequent hospital stays, Plan M could be the perfect fit for you. You’ll save money on monthly premiums, but still have peace of mind knowing you’re covered for major medical events.

On the flip side, if you’re worried about the possibility of a long hospital stay and want to make sure you’re fully covered, it might be worth considering a plan like Plan G that takes care of the full deductible. It all comes down to how much risk you’re comfortable with and what your budget looks like.

Conclusion:

Medicare Supplement Plan M is like a sweet spot for those looking for balance. It gives you strong coverage where it counts, like doctor visits and skilled nursing care, while keeping premiums manageable by sharing part of the hospital deductible. In short, if you’re looking for a cost-effective option that doesn’t skimp on coverage, Plan M might just be the perfect match. Take your time, consider your health needs, and maybe even chat with an advisor to see if Plan M aligns with what you need. The great thing about Medigap is that it offers flexibility—you just have to pick the plan that feels right for you.

Top4u