Medicare Supplement Plan M is used with your Original Medicare and is commonly called Medigap.
Medigap health insurance coverage is used to help fill gaps in coverage left for the insured to pay once Medicare has paid their portion of the bill.
Plan M will only pay a portion of the cost remaining once Medicare pays its portion of the bill.
Plan M doesn’t cover all medical costs leaving a portion of out-of-pocket expenses for the insured to pay.
Educate yourself about the different plan options before choosing a Plan.
Plan F and Plan G are the most comprehensive options with the best overall coverage; however, these plans cost more.
*For people who are new to Medicare, Plan F is no longer available unless you turned 65 before January 1, 2020. If you already have Plan F, you can still hold on to it.
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Plan M will fill in the gaps for:
- Hospital stays
- Skilled nursing facility care
- Medicare Part A Hospice care
You must pay a portion of your Part A deductible; Plan M only pays some of the rest.
Plan M pays the remaining percentage of your Medicare-approved medical expenses which are not covered directly by Medicare. Typically, this is 20% of your approved healthcare expenses, but doesn’t cover one benefit that’s included in some other plans available to new Medicare members: Medicare Part B excess charges (if a provider is permitted to charge more than Medicare’s approved amount and does so).
The medical cost might occur through:
- Your physician
- Treatments, Inpatient or outpatient surgeries
- Your approved supplies
- Therapies
- Equipment
- Additional expenses for medically necessary and approved by Medicare.
Plan M doesn’t cover your Medicare Part B deductible or any of your Part B excess charges.
Plan M Benefits
Also included in Plan M benefits are when blood is needed during any of your medical procedures or surgery. Medicare coverage will begin after your first 3 pints of blood. Plan M will then cover these first 3 pints, and no additional expense is made to the insured. There is some emergency care for your foreign travel which is provided. After the insured has paid the deductible, then Plan M covers 80% of the necessary medical expenses.
You, the patient, are still responsible for paying 20% for these expenses. Plus, there is a lifetime limit for foreign travel medical benefits. Use the chart below to compare Medigap Plan M to the other options available.
| Medigap Benefits | Medigap Plans | |||||||||
| A | B | C | D | F* | G* | K | L | M | N | |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes*** |
| Blood (first 3 pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled nursing facility care coinsurance | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A deductible | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B deductible | No | No | Yes | No | Yes | No | No | No | No | No |
| Part B excess charge | No | No | No | No | Yes | Yes | No | No | No | No |
| Foreign travel exchange (up to plan limits) | No | No | 80% | 80% | 80% | 80% | No | No | 80% | 80% |
| Out-of-pocket limit** | N/A | N/A | N/A | N/A | N/A | N/A | $7,060 in 2024 ($7,220 in 2025) | $3,530 in 2024 ($3,610 in 2025) | N/A | N/A |
(source)
*Plans F & G offer a high deductible plan in some states.
**Plans K & L show how much they’ll pay for approved services before you meet your out-of-pocket yearly limit and Part B deductible. After you meet them, the plan will pay 100% of your costs for approved services.
***Plan N pays 100% of the costs of Part B services, except for copayments for some office visits and some emergency room visits.
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