Medigap Plan M

Medicare Supplement Plan M is a “fairly new” Medicare Supplement created by Medicare in 2010, as part of the Medicare Modernization Act.
Medicare Supplement Plan M will pay 50% of the Medicare Part A hospital deductible. It also provides 365 days of hospital coverage.
Medicare Supplement Plan M does not pay the annual Medicare Part B deductible or excess charges. It does however cover the remaining 20% of expenses that Medicare Part B does not cover.

Although Medicare Plan M offers comprehensive coverage, it unfortunately is not offered in all markets, and therefore may not be an option in your zip code.


Medigap Plan M - Consider this Scenario

Mr. Morris is relatively healthy, an avid runner, and recently retired with a considerable nest egg. He buys a Medigap Plan M for his coverage and feels he will enjoy the savings on the yearly Medigap premiums. Mr. Morris also doesn’t mind paying for the occasional 50% co-insurance on the Part A deductible that he may incur. A few years into his retirement, he needs knee surgery which requires an overnight stay in the hospital. Mr. Morris will pay $670 in 2018 for his share of the Medicare Part A deductible not covered by his plan.

Mr. Morris’s Plan M will also cover most of his physical therapy treatments and outpatient follow-ups. Medicare pays 80% of his outpatient car, after he meets the $183 Medicare Part B deductible. His Medicare Supplement Plan M picks up the other 20%. If his knee surgeon does not accept Medicare’s assigned rates, he may also be responsible for the Medicare Part B Excess Charges. These charges are limited to 15% above what Medicare allows the doctor to charge. Mr. Morris feels confident that his potential cost sharing is minimal, so it’s not a big deal for him.

So, if you’re like most people when it comes to understanding cost-sharing and trying to figure out which insurance companies offer a Plan M, you may feel like your “spinning-your-wheels” just trying to figure it all out. If so, you’re not alone . . .
Fortunately, the trusted insurance agents at New Jersey Medicare Plan can help - just give us a call at 1 (844) 280 -0785 and we’ll do the heavy lifting for you!

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Plan A | Plan B | Plan C | Plan D | Plan F | Plan G | Plan K | Plan L | Plan M | Plan N


 

Medicare Supplement Insurance Plans (Medigap)
Benefits A B C D F* G K L M N
Part A coinsurance and
hospital costs (up to an
additiona 365 days after
Medicare benefits are used)
100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Part B coinsurance or
copayment
100% 100% 100% 100% 100% 100% 50% 75% 100% 100%**
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care
coinsurance or copayment
100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care
coinsurance
    100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible   100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible     100%   100%          
Part B excess charges         100% 100%        
Foreign travel emergency
(up to plan limits)
    80% 80% 80% 80%     80% 80%
Out-of-pocket limit***
(2018)
            $5240 $2620    

 

* Plan F is also offered as a high- dedutible plan by some issuers in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2240 in 2018 before your policy pays anything.
** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
*** For Plans K and L, after you meet your out-of-pocket yearly limits and your yearly Part B deductible ($183 for 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year.