Medigap Plan M is a Medicare supplement insurance plan that offers coverage for certain medical costs not covered by Original Medicare. It provides a moderate level of coverage, striking a balance between benefits and out-of-pocket costs.
With Medigap Plan M, you can expect coverage for Medicare Part A coinsurance and hospital costs, as well as Medicare Part B coinsurance or copayment. The plan covers 50% of your Part A hospice care coinsurance or copayment, and 50% of skilled nursing facility care coinsurance. However, it does not cover the Part A deductible or excess charges. One unique feature of Medigap Plan M is the inclusion of a cost-sharing arrangement. This means that you will be responsible for paying 50% of the Medicare Part A deductible, which is a set amount you need to pay before Medicare coverage begins.
Medigap Plan M can be a suitable choice if you're looking for a plan with lower premiums compared to some other Medigap plans. However, it's important to evaluate your healthcare needs and budget to determine if this plan aligns with your coverage preferences.
Below is a comprehensive list of the covered services provided by Medicare Supplement Plan M, which include benefits under Medicare Part A, Medicare Part B, and other areas:
Service | Who pays what? |
---|---|
First 60 days | Medicare pays: All cost but $1,632 Plan pays: 50% of Part A Deductible ($816) Member pays: N50% of Part A Deductible ($816) |
61st thru 90th day | Medicare pays: All cost but $408/day Plan pays: $408/day Member pays: Nothing |
91st day and after (While using 60 lifetime reserve days) | Medicare pays: All cost but $816/day
Plan pays: $816/day Member pays: Nothing |
Once lifetime reserve days are used; additional 365 days | Medicare pays: Nothing Plan pays: 100% of Medicare-eligible expenses Member pays: Nothing |
Beyond the additional 365 days | Medicare pays: Nothing
Plan pays: Nothing Member pays: All cost |
Service | Who pays what? |
---|---|
First 20 days | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
21st thru 100th day | Medicare pays: All but $204/day Plan pays: Up to $204/day Member pays: Nothing |
101st day and after | Medicare pays: Nothing Plan pays: Nothing Member pays: All cost |
Service | Who pays what? |
---|---|
First three pints | Medicare pays: Nothing Plan pays: All cost Member pays: Nothing |
Additional amount | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
Service | Who pays what? |
---|---|
Hospice Care | Medicare pays: All but very limited
copayment/ coinsurance for outpatient drugs and inpatient respite care Plan pays: Medicare copayment and coinsurance Member pays: Nothing |
Service | Who pays what? |
---|---|
Part B Deductible | Medicare pays: Nothing Plan pays: Nothing Member pays: $240 (Part B Deductible) |
Part B Coinsurance | Medicare pays: 80% Plan pays: 20% (Part B Coinsurance) Member pays: Nothing |
Part B Excess Charges
(above Medicare approved amounts) | Medicare pays: Nothing Plan pays: All cost Member pays: Nothing |
Service | Who pays what? |
---|---|
Test for diagnostic lab services | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
Service | Who pays what? |
---|---|
First three pints | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
Additional amount (First $226 of
Medicare approved amounts) | Medicare pays: Nothing Plan pays: Nothing Member pays: $240 (Part B deductible) |
Remainder of Medicare approved amounts | Medicare pays: 80% Plan pays: 20% (Part B Coinsurance) Member pays: Nothing |
Service | Who pays what? |
---|---|
Medically necessary skilled care
services and medical supplies/ Durable medical equipment (First $226 of Medicare approved amounts) | Medicare pays: Nothing Plan pays: Nothing Member pays: $240 (Part B deductible) |
61st thru 90th day | Medicare pays: 80% Plan pays: 20% (Part B Coinsurance) Member pays: Nothing |
Service | Who pays what? |
---|---|
First $250 each calendar year/Remainder of charges | Medicare pays: Nothing (exccept under limited circumstances) Plan pays: $0/80% to a lifetime maximum of $50,000 Member pays: $250/20% and amounts over the $50,000 lifetime maximum |
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