What Is Medigap Plan M?

Written by:

Brenna Swanston

Reviewed by:

Amy Albert

5 min read

Key Takeaways

Medigap Plan M covers 50% of the Medicare Part A deductible, 100% of copays and coinsurance, and offers partial coverage for healthcare expenses while traveling abroad.
This Medicare Supplement insurance plan helps reduce out-of-pocket costs related to hospital stays, skilled nursing facilities, hospice care, and blood transfusions, but does not cover the Medicare Part B deductible or excess charges.
Medigap Plan M offers lower monthly premiums compared to other Medigap plans, making it a cost-effective option for beneficiaries seeking mid-range coverage.
Like all Medigap plans, Medicare Supplement Plan M’s benefits are consistent across providers, but premium costs can vary based on factors such as age, location, and enrollment timing.

Medicare Supplement Plan M pays for half of the Medicare Part A deductible and 100% of copays and coinsurance to reduce out-of-pocket spending for Medicare beneficiaries. Though other Medigap plans may offer more robust coverage than Plan M, Plan M comes with a lower premium price than many alternative options.

If you’re looking to augment your Original Medicare coverage at a mid-range price point, Medicare Supplement Plan M could help get the job done. Here’s what you need to know about Medigap Plan M.

Medigap At a Glance

Medigap, also known as Medicare Supplement Insurance, helps fill coverage gaps for Original Medicare beneficiaries. If you have Original Medicare (Parts A and B), you can also purchase Medigap from a private insurance company to cover some out-of-pocket costs, such as deductibles, copays, and coinsurance.

Medigap plans are very common. In 2022, 42% of those with traditional Medicare plans also had Medigap policies. However, not all Medigap plans are created equal; Medicare Supplement Plan M is just one of 10 available options.

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Understanding Medigap Plan M

Medicare Supplement Plan M fills in some gaps in Original Medicare coverage. Plan M will pay for certain out-of-pocket expenses left over after you’ve used your Medicare benefits.

Key Features of Medigap Plan M

Part A coverage. Covers Medicare Part A coinsurance and hospital costs, including hospice care and skilled nursing facilities. Also covers half of the Part A deductible.
Some Part B coverage. Covers Part B coinsurance and copayments.
International care. Partially covers emergency healthcare expenses while traveling abroad.

What Does Medigap Plan M Cover?

Like other Medigap policies, Plan M does not offer benefits outside of the scope of Original Medicare, but it does help pay for out-of-pocket costs not covered by Original Medicare.

Plan M provides complete coverage for:

Coinsurance and copays for Original Medicare Parts A and B
Hospital costs for up to 365 days after the patient has exhausted their Medicare benefits
Expenses related to hospice and skilled nursing facility care
Blood transfusions for up to 3 pints, after which Original Medicare coverage kicks in

Medigap Plan M does not cover the Part B deductible or excess charges, but it does pay for 50% of the Part A deductible. Should you have a medical emergency while abroad, your Plan M benefits could cover up to 80% of those expenses.

Costs For Medigap Plan M

Though different private insurance companies offer Plan M policies, the plan’s benefits are standardized among providers. A differentiating factor is cost, which varies depending on your age, sex, location, health status, and when you enroll.

Premiums: Expect to pay a monthly premium for Medigap Plan M. You’ll pay this cost in addition to any premium associated with Original Medicare. Plan M premiums can range from less than $100 to more than $500 per month, depending on where you live.
Deductibles: Medigap Plan M helps pay the deductibles associated with Medicare Parts A and B. Plan M covers 50% of the Part A deductible, which is $1,676 in 2025. Plan M does not cover the Part B deductible of $240 in 2025.
Copays: A copay is a fixed amount you’ll have to pay out of pocket before your benefits kick in. Plan M covers your copays for Medicare Parts A and B.
Coinsurance: Coinsurance functions similarly to copays, except it’s a set percentage of your total medical bill instead of a fixed amount. Plan M covers 100% of any coinsurance you owe after Part A or Part B coverage.

See It In Action

Let’s look at a hypothetical example to see how Medigap Plan M might work: Jane has Original Medicare and Medigap Plan M. She undergoes a scheduled knee replacement surgery in the hospital. The surgery is successful with no complications, but Jane has to stay for another two days after the surgery for initial recovery. She then attends physical therapy weekly for six weeks. Here’s how Jane’s out-of-pocket (OOP) treatment expenses might look:

Treatment	Upfront cost	Medicare coverage	Plan M coverage added
Knee replacement surgery	$18,000	100% after $1,676 Part A deductible (OOP reduced to $1,676)	50% of Part A deductible (OOP reduced to $838)
Two-day hospital stay	$6,000	100% with Part A deductible met (OOP reduced to $0)	N/A
Physical therapy	$600 ($100 per session for six sessions)	80% after $257 Part B deductible (OOP reduced to $326)	100% of Part B coinsurance (OOP reduced to $257)
Total out-of-pocket cost	$24,600 upfront cost	$1,944 with Medicare only	$1,056 with Medigap Plan M

How Medigap Plan M Compares With Other Mid-Coverage Medigap Plans

Benefits	Plan M	Plan D	Plan G
Available to those who became eligible for Medicare in or after 2020?	Yes	Yes	Yes
Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed	Yes	Yes	Yes
Part B coinsurance or copayment	Yes	Yes	Yes
Part A hospice care coinsurance or copayment	Yes	Yes	Yes
Part A deductible	50%	Yes	Yes
Part B deductible	Not covered	Not covered	Not covered
Part B excess charge	Not covered	Not covered	Yes
Out-of-pocket limit	N/A	N/A	N/A
Blood (first three pints)	Yes	Yes	Yes
Skilled nursing facility care coinsurance	Yes	Yes	Yes
Foreign travel exchange up to plan limits	80%	80%	80%

How to Choose a Medigap Plan

Most states offer 10 types of Medicare Supplement plans, differentiated by letter labels: Plans A, B, C, D, F, G, K, L, M, and N. All Medigap plans pay for out-of-pocket costs remaining after Medicare coverage, but differ in what and how much is covered. Here’s how to choose the best Medigap plan for you.

Evaluate your health needs. How often do you typically require care? Do you have any conditions for which you might need surgery or inpatient treatment? Do you take prescription drugs? Each Medigap plan type offers different levels of coverage, so use the frequency and costs of your anticipated medical visits to inform your plan choice.
Assess your coverage options. Once you understand your personal health needs, compare plan letters to see which plan would best serve you. Look over coverages for copayments, coinsurance, deductibles, inpatient expenses, excess costs, and foreign travel emergencies.
Consider your budget. Several factors, including location, health status, and age, can influence premium prices for Medicare Supplement plans. However, if you enroll when you are first eligible for Medigap, your health status will not affect your premium price.
Research plan providers. You’ll purchase your Medigap plan through a private insurance company. Read reviews and talk with your trusted healthcare providers to get an understanding of company reputations.

Once you’ve determined the best plan type for your budget and coverage needs and chosen a dependable provider, it’s time to enroll. The most convenient time to purchase a Medigap plan is when you first enroll in Medicare.

After that seven-month initial enrollment period — which starts three months before your 65th birthday and ends three months after your birthday month — your health status can affect your Medigap premium price and also affect which plans are available to you.

Putting It All Together

Original Medicare does not cover everything, and Medicare Supplement Insurance helps pay for your portion of Medicare’s out-of-pocket expenses. Medigap Plan M mitigates costs associated with copays, coinsurance, inpatient treatments, and Medicare deductibles. While Plan M only covers a portion of your Medicare deductibles, it does so at a lower premium price point than many other Medigap plans.

Choosing the best Medicare Supplement plan can be a complicated process. Consider working with a licensed insurance agent or broker to ensure you’re choosing the best Medigap plan for your unique health needs — and your budget.