Medigap Plan M

Medigap Plan M is a type of Medicare Supplement insurance that helps cover some of the out-of-pocket costs associated with Original Medicare. This plan is one of ten standardized Medigap plans available in most states, and is designed to help fill in the gaps left by Medicare Parts A and B.

What is Medigap Plan M?

Medigap Plan M provides a mix of cost-sharing and coverage for some of the benefits that are not covered by Medicare, including:

  • Medicare Part A coinsurance and hospital costs: Plan M covers the Part A coinsurance and hospital costs for up to 365 days after you use up your Medicare benefits.
  • Medicare Part B coinsurance or copayment: Plan M covers 50% of the coinsurance or copayment amount for Medicare Part B services, such as doctor visits and outpatient care.
  • Blood: Plan M covers the first three pints of blood you need each year.
  • Hospice care: Plan M covers the Part A coinsurance for hospice care.
  • Skilled nursing facility care: Plan M covers the coinsurance for care in a skilled nursing facility.

How does Medigap Plan G work?

Plan M has an annual out-of-pocket limit, which is set at $3,220 in 2022. This means that once you reach this limit, your Plan M coverage will cover all Medicare-approved costs for the rest of the year.

However, it’s important to note that Plan M does not cover some of the benefits that are covered by other Medigap plans, such as the Medicare Part B deductible and excess charges. If you choose Plan M, you may be responsible for paying these costs out of pocket.

In addition to the benefits provided by Plan M, there are also some limitations and restrictions to consider. For example:

  • Plan M may not be available in all states or from all insurance companies.
  • Premiums for Plan M may vary depending on the insurance company and your location.

Some states have a “birthday rule” that allows you to switch from one Medigap plan to another within a certain timeframe each year, regardless of your health status.

Medigap plans do not include prescription drug coverage, so you may need to enroll in a separate Medicare Part D plan to cover your prescription medications. If you enroll in a Medicare Advantage plan, you cannot use a Medigap plan to supplement your coverage.

When considering whether Plan M is the right choice for you, it’s important to take into account your individual healthcare needs and budget. You may want to compare the costs and benefits of different Medigap plans available in your area, as well as consider any state-specific rules or restrictions.

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