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Pomona, California

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Plan M

There are 10 standardized Medigap plans available in most states and they are lettered from Plan A to Plan N. All the plans differ in terms of coverage for services, out-of-pocket limits, and premium costs.Plan M offers supplemental coverage or Original Medicare and as a relatively low monthly premium. It’s great for Medicare beneficiaries who are financially prepared to pay out-of-pocket for some of their healthcare expenses.

Coverage Details​

MEDIGAP PLAN M

Medigap Plan M is one of the cost-sharing Medigap policies. Out of all the three available cost-sharing plans, plan M offers the most comprehensive benefits. The only cost-sharing that is required is for the Part A deductible. Plan M members will need to pay 50% of the Part A inpatient deductible.

Plan M will pay for all of your coinsurance and copays associated with Medicare Part B. Also it will cover the Part A inpatient coverage up to 365 days after the Part A benefits have been exhausted.

Plan M does not cover the Part B deductible or Part B excess charges. Not every state allows Part B excess charges, so if you reside in one of those states, this is not an issue. Excess charges are not common, even in states that allow them.

MEDIGAP PLAN M COVERS:

  • Part A coinsurance and up to an additional 365 days of hospital costs after Medicare benefits are exhausted
  • Part B coinsurance/copayment
  • Blood (3 pints)
  • Part A hospice coinsurance/copayment
  • Skilled nursing facility care coinsurance
  • 50% of the Part A deductible
  • 80% of foreign travel exchange
  • No out-of-pocket limit

What Medicare Supplement Plan M Doesn't Cover

  • 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.

Individuals Who Benefit from Plan M

Medigap Plan M is a good option for individuals who would like coverage outside of Original Medicare and don’t mind paying 50% of hospital costs. Plan D is also great for individuals who like to occasionally travel outside of the United States and are looking for a plan with a lower monthly premium.

Medigap Plan M Premiums

Individual premiums will vary based on which state the individual is seeking coverage in, which carrier they’re purchasing from, and also individual factors like gender, age, tobacco use, and a few other details. The average cost for Plan M ranges from $120-$2000 each month. In general, Plan M premiums are higher in states who have a higher cost of living.

Plan M and Prescription Drug Coverage

Medigap Plan M does cover prescription drugs administered while under inpatient care. However, it does not cover medications that have been prescribed by a doctor and are administered at home. Medigap plan members will need to enroll in a stand-alone Part D plan to get prescription drug coverage.

The Best Alternative to Plan M

There are several good alternatives to Plan M, depending on how much an individual wants to pay for the monthly premium. More comprehensive coverage is offered by Plans F and G, but they come with the highest premiums. The other two cost-sharing plans are Plans K and L. They have less coverage than Plan M, but also have lower monthly premiums.

How to Compare

MEDIGAP PLAN M RATES

There is a lot of information about each plan online, but to get an accurate quote, you’ll need to enlist the help of a licensed Medicare agent. Instead of calling each insurance carrier to get a quote, we can compare premiums across many different carriers, ensuring that you enroll with one that gives you the best rate.

We’ll need to collect some information from you in order to provide quotes since your premium is based on your information and health history, but our services come at no additional cost to you! If you choose to enroll in a Medigap plan through our agency, we also offer unlimited support. If you have problems with your coverage or have questions about how your plan works, we will be here to help.

TALK WITH AN ADVISOR

QUESTIONS TO BE ADVISED ON:

Medicare cost in California
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“Part N” is incorrect terminology. “Parts” only refer to Original Medicare (Parts A and B), Medicare Advantage plans (Part C) and prescription drug plans (Part D).

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Yes, Plan M is available for all Medicare beneficiaries to enroll in.

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As with every other aspect of Medicare, the answer to that question depends on your healthcare needs and budget. The difference between the two plans involves the cost-sharing portion. Plan M requires 50% cost-sharing for the Part A deductible and Plan N requires copays for Part B.

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Yes, you may enroll in a Medigap plan at any point in the year. If you missed your open enrollment window, you will have to answer questions about your health history and be approved for coverage.

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If your doctor attests that physical therapy is medically necessary, Plan N will pay for the service.

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No, Plan N does not offer dental benefits. Plan N members should consider enrolling in a separate Dental, Vision, Hearing (DVH) plan to get coverage on these services.

At California Medicare Agency, we specialize exclusively in Medicare. With an average of 10 years of experience, our brokers focus on educating you first so your decision can be an informed one. 

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We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options. Health Insurance sold on www.californiamedicareagency.com is processed through the licensed entity: Connor Cunningham Agency, Inc. 2023 All rights Reserved.

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