If you are on Medicare, you are probably aware that if you do not have additional insurance, you may be responsible for large out-of-pocket expenses. However, there are ten Medicare Supplement Plans. Each of them works in conjunction with Original Medicare to help you manage these out-of-pocket expenses. Medicare Supplement Plan M is one of these ten Medicare Supplement Plans.
Medicare Supplement Plan M is a Medicare Supplement Plan with a cost-sharing component that keeps monthly premiums low. All while providing essential healthcare benefits. But while your monthly premiums will be low, you must be ready to pay out-of-pocket expenses when receiving healthcare services with Plan M. This includes the first half of your Medicare Part A deductible.
Despite these out-of-pocket expenses, many enrollees are happy with Plan M because its premiums are lower than those of some other Medicare Supplement Plans.
What Medicare Supplement Plan M Covers
Medicare Supplement Plan M covers the majority of the costs associated with Original Medicare, but not all of them. It also has an out-of-pocket limit that once you meet, your insurer will pay your bills in full.
Medicare Supplement Plan M covers all of Medicare Part A coinsurance and hospital costs. It also covers:
- Medicare Part B coinsurance – Medicare Part B typically charges a coinsurance for doctor visits and other outpatient care. Part B pays 80% of the Medicare-approved amount for covered services. And once you’ve met your Part B deductible ($226 per year in 2023), you’ll be on the hook for the remaining 20% of the costs for your covered care (your coinsurance). Plan M pays your Part B coinsurance and/or copayments in full.
- Blood – If you require a blood transfusion as part of your medical treatment, Original Medicare will only pay for the fourth pint of blood and beyond. If you require blood while in the hospital, Medicare Supplement Plan M will cover the first three pints.
- Part A hospice care coinsurance or copayment – Hospice care is covered by Medicare, but there are copayments. Copayments for certain prescription drugs are generally $5. Plus you will have to pay 5% of the Medicare-approved amount for inpatient respite care. Plan M will cover all of your hospice care coinsurance and copays.
- Skilled nursing facility care coinsurance – If you are admitted to a skilled nursing facility for care, you must pay Part A coinsurance if your stay exceeds 20 days. After day 20 of your stay, the Part A coinsurance cost is $200 per day (in 2023). Plan M covers the entire cost of Part A skilled nursing facility coinsurance.
- Part A deductible – If you are admitted to a hospital for an inpatient stay, Medicare Part A requires you to meet a deductible before any of your Part A benefits kick in. The Part A deductible in 2023 is $1,600 per 60-day benefit period. Because this is not an annual deductible, you may have to meet the Part A deductible more than once in a single year. Medicare Supplement Plan M will cover half of your Medicare Part A deductible. If you have Plan M, you will have to pay half of the $1,600 (or $800) deductible rather than the full $1,600.
What Isn’t Covered?
If your provider charges more than Medicare’s approved amount, you will have to pay what is known as Medicare Part B excess charges. Medicare Supplement Plan M does not cover these excess charges.
In addition, all Medicare Supplement Plans sold to new Medicare members, including Plan M, do not cover the following:
- Part B deductible
- Prescription drugs
- Long-term care (like non-skilled care you get in a nursing home)
- Dental care
- Vision care
- Private-duty nursing
The Cost of Medicare Supplement Plan M
Medicare Supplement Plan M premiums typically cost between $120-$200 per month. Which is lower than for other Medicare Supplement Plans because of Plan M’s cost-sharing component. Most notably the fact that it only covers half of the Medicare Part A deductible.
Remember, though, while the government standardizes and regulates Medicare Supplement Plans, private insurance companies sell them. These companies set premiums based on factors such as age, location, and tobacco use.
That means the average price listed above can vary based on the insurance company who supplies. In addition, you should be aware that there are three pricing options for Medicare Supplement Plans: community-rated, issue-age-rated, and attained-age-rated.
- Community-rated – With this type of pricing, everyone who has the same Medicare Supplement Plan pays the same monthly premium, regardless of age. Premiums may rise due to inflation and other factors, but not due to your age.
- Issued-age-rated – In this case, your premium is determined by the age you are when you purchase the Medicare Supplement Plan. Premiums will be lower the younger you are and will not increase as you get older. Premiums may rise due to inflation and other factors, but not due to your age.
- Attained-age-rated – With this type of pricing, your premium is calculated based on your current age, with the premium increasing as you get older. Premiums will be lower when you are younger, but they will continue to rise as you get older. Premiums may also rise as a result of inflation or other factors.
Enrolling in Medicare Supplement Plan M
The best time to enroll in a Medicare Supplement Plan is during your Medicare Supplement Open Enrollment Period. This is because you will be given guaranteed issue rights if you enroll during this time. Meaning insurance companies will not be able to deny you coverage or charge you more for a plan because of your health.
This period is only open to you once, so it’s important to take advantage of it. Your Open Enrollment Period starts when you reach the age of 65 and enroll in Medicare Part B. The Open Enrollment Period lasts for six months. If you continue to work after the age of 65, and have a creditable group employer plan, your six-month period begins when you stop working or lose that insurance.
Insurance companies cannot consider your health or medical history when determining your premium. This means Medicare Supplement Plans are the most affordable and easiest to obtain during this Open Enrollment Period.
If you do not apply for a Medicare Supplement Plan during this period, or wait too long after your OEP, you may have to undergo a medical exam or a review of your medical history (underwriting). Your application may also be denied based on any pre-existing health conditions.
- What’s the difference between Plan M and Plan N?
If you compare Medicare Supplement Plan M to Plan N, you’ll notice that the benefits are very similar. However Plan N provides more coverage. Although they are nearly identical, Medicare Supplement Plan N covers the entire Medicare Part A Deductible. Whereas Medicare Supplement Plan N covers just half of it.
Furthermore, you’ll notice that the way cost-sharing works differs significantly between Medicare Supplement Plans M and N. Medicare Supplement Plan M requires you to contribute to the cost of your Medicare Part A deductible. Whereas Medicare Supplement Plan N has small copays for Medicare Part B services.
- Is there another plan that is similar to Plan M?
The benefits of Medicare Supplement Plan M are the same as those of Medicare Supplement Plan D. With the exception that with Plan M, you pay half of the Medicare Part A deductible while Plan D covers the entire Part A deductible.
- Why should I choose Plan M?
If your healthcare providers do not charge more than the Medicare-approved amount, and you know you won’t be charged excess charges, Medicare Supplement Plan M may have the right level of coverage for you. Otherwise, you should look for a plan that covers these costs, such as Medicare Supplement Plan G.
Plan M’s availability is limited: many carriers do not offer it, so you may be unable to apply for it or find a plan at a competitive rate. Medicare Supplement Plan M may be the best option for you, but it’s a good idea to compare your Medicare Supplement Plan options before making a decision.
How EZ Can Help!
If you’re looking for a Medicare Supplement Plan, it is essential that you compare the benefits and costs of each one. That means doing a lot of research, which can take a long time, since you’ll have to call multiple insurance companies to get rate quotes.
But that’s where EZ can help! If you work with one of EZ’s agents, you can cut the time it takes to compare prices in half. Working with a licensed agent gives you access to multiple Medicare Supplement Plan carriers and plans in one place, virtually eliminating the need for you to do any extra research on your own.
Your agent can explain the differences between each plan, in addition to offering your price comparisons. Furthermore, your agent can help you weigh out-of-pocket costs versus premium costs. They can help you determine which plan will be the most cost-effective for you overall. To begin comparing Medicare Supplement Plans call us at 877-670-3602 today or enter your zip code in the box below to compare plans online.