Medigap Plan M Supplement Insurance

Medigap Plan M is a Medicare Supplement insurance plan that helps pay out-of-pocket costs that Original Medicare – Medicare Part A and Part B – does not cover. It is similar to Medigap Plan D, except that it only pays half of the Medicare Part A deductible.

What Does Medigap Plan M Cover?

Medigap Plan M is one of several plans sold by private insurers that help people cover the “gaps” in their coverage with Original Medicare – Medicare Part A and Part B.

Also called Medicare Supplement Plan M, it covers most typical out-of-pocket costs associated with Original Medicare. But it pays only half of your Medicare Part A deductible if you are hospitalized.

Medigap Plan M Coverage
Medicare Part A deductible – $1,556 in 2022 50%
Medicare Part A coinsurance and hospital costs – up to 365 days after Medicare benefits run out 100%
Medicare Part A hospice care coinsurance or copayment 100%
Skilled nursing facility care coinsurance 100%
Medicare Part B coinsurance or copayment 100%
Medicare Part B deductible – $233 in 2022 NO
Medicare Part B excess charges (the amount a doctor or other provider can charge above the Medicare-approved cost) NO
First three pints of blood for medical procedures each calendar year 100%
Foreign travel medical emergency cost (up to plan limits) 80%

Medigap Plan M – like all other Medigap Plans – does not provide dental, vision, hearing or prescription drug coverage. You can purchase a Medicare Advantage plan that will cover these costs.

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Learn how to join, switch, or drop your Medicare Advantage plan before time runs out on March 31, 2022.

Alternatively, you can add a Medicare Part D prescription drug plan to your Original Medicare to cover prescription medicine costs. But it still won’t cover hearing, dental and vision care.

You cannot add any Medigap plan to a Medicare Advantage plan.

How Much Does Medigap Plan M Cost?

Medigap Plan M has a lower monthly premium than comparable Medicare supplement plans. But the trade-off is that you have to pay half of your Medicare Part A hospital insurance deductible.

Where you live, when you purchase your plan and other factors may affect how much your monthly premium will be.

Medigap plans are standardized – meaning that no matter where you buy a Medicare Plan M policy, the benefits will be the same. But Medigap plans are sold by private insurers, and each insurance company uses different measures to set its monthly premium.

Did You Know?
While there are 10 standardized Medigap plans available in most states, three states – Massachusetts, Minnesota and Wisconsin – have their own versions of Medigap. These plans are standardized across each state but may not offer the same benefits as Medigap Plan M.
Source: U.S. Centers for Medicare & Medicaid Services

Medigap Plan M vs. Medigap Plan D

The biggest difference between Medigap Plan M and Medigap Plan D is how much each pays toward your Medicare Part A deductible – $1,556 in 2022. Medigap Plan M pays 50 percent of this deductible, while Medigap Plan D covers the full deductible. 

The trade-off is that monthly premiums for Plan M will likely be less than those for Plan D.

Monthly premiums for Medigap Plan M and Plan D vary depending on where you live and other factors. If you’re considering both Medigap plans, compare costs among different insurance companies selling one or both.

Who Needs Medigap Plan M?

Medigap Plan M is best suited for people who don’t mind paying the Medicare Part A deductible and who live in states that don’t allow Medicare Part B excess charges.

Doctors are allowed to charge up to 15 percent above the Medicare-approved cost for services. Under Plan M, you have to pay this excess charge out of your pocket.

But if you live in one of the eight states that prohibit excess charges, Plan M may again be worth considering.

States that Prohibit Medicare Part B Excess Charges

Medicare Part A hospital insurance only comes into play if you are admitted as an inpatient to a hospital. If you don’t expect you’ll need to be hospitalized – or can afford half the cost of the deductible – Medigap Plan M may be worth considering.

Last Modified: January 12, 2022

6 Cited Research Articles

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