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Medicare: Everything You Need to Know About Medigap Plan M

Medicare is a government-run health insurance program that provides coverage for seniors and people with disabilities. In contrast, Medigap is a type of health insurance private companies offer to supplement…

September 1, 2022

Written by Gary Martin

Medicare is a government-run health insurance program that provides coverage for seniors and people with disabilities. In contrast, Medigap is a type of health insurance private companies offer to supplement your Original Medicare coverage. It covers many medical expenses that Medicare doesn’t, including copayments, coinsurance, and deductibles.


There are many different types of Medigap plans available, and each one has its unique benefits and features. Medigap Plan M, specifically, is a prevalent option because it offers more benefits than many of the other plans available. If you’re looking for comprehensive coverage, you may want to consider Medigap Plan M.


This blog post will discuss what Medigap Plan M covers, who’s eligible to enroll, and how much it costs. We’ll also compare its benefits to those of other supplemental insurance plans so you can make an informed decision about which is best for you and your loved ones. Whether you’re about to turn 65 or already on Medicare, you’re sure to find this information helpful.

What Is Medigap Plan M?

As mentioned in the beginning, Medigap Plan M is a type of health insurance that supplements your Original Medicare coverage. Similar to other Medigap plans, Plan M is offered by private companies and isn’t run by the government.


Medicare standardizes all supplement insurance plans, so each Medigap Plan M policy must provide the same basic benefits regardless of which company you purchase it from. Therefore, a Plan M policy acquired in Texas will offer the same benefits as one in Connecticut. The only difference between policies may be the price, so it’s essential to research and compare rates before enrolling in a plan.

What Does Medigap Plan M Cover?

Medigap Plan M covers many medical expenses, including copayments, coinsurance, and deductibles. It also covers some foreign travel emergency care expenses.

Here’s a more detailed list of what Medigap Plan M covers:

  • 100% of Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • 50% of Part A deductible
  • 100% of Medicare Part A hospice care coinsurance or copayment
  • 100% of Part B coinsurance or copayment
  • The first three pints of blood needed for a transfusion each year
  • 100% of skilled nursing facility care coinsurance
  • Up to 80% of foreign travel emergency costs

What Does Medigap Plan M Not Cover?

Plan M doesn’t cover the Part B deductible. This is the amount of money you must pay out-of-pocket each year before your Medigap plan begins to pay its share of covered costs. The Part B deductible for 2022 is $233. Plan M also doesn’t cover excess charges, which are medical costs above what Medicare approves.


Outpatient prescription drug charges can’t be covered by any Medigap plan, including Plan M. This means that you’ll be responsible for paying for all of your prescription drug expenses out-of-pocket. Finally, Plan M doesn’t cover long-term care, dental care, vision care, or hearing aids.

Medigap Plan M Eligibility

You must have Medicare Part A and Part B to be eligible for Medigap Plan M. You can qualify for Medicare benefits if:

  • You’re 65 years of age or older.
  • You’ve received Social Security Disability Insurance (SSDI) for 24 months.
  • Some people with specific disabilities can qualify for Medicare before they turn 65. For example, End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).


There are a few exceptions to who can enroll in Medigap Plan M. People with Medicare Advantage Plans or other types of health coverage through an employer aren’t eligible to enroll in a Medigap Plan. If you’re not sure whether you’re suitable for Medigap Plan M, you can contact your insurance company or the Social Security Administration to find out.

When Can I Sign Up For Medigap Plan M?

Medigap Open Enrollment Period

Open Enrollment is the 6 months when you’re first eligible to enroll in a Medigap plan. This period starts on the first day of the month that you’re both 65 years old and enrolled in Medicare Part B.


During Medigap Open Enrollment, you can enroll in any Medigap plan available in your state, even if you have health problems. You don’t have to answer any medical questions, and insurance companies can’t refuse to sell you a policy or charge you more because of your health.


As mentioned before, you might not be eligible for Medigap Open Enrollment if you have group health coverage through an employer. However, when your employer-provided coverage ends, you’ll have the option to enroll in Part B without incurring a penalty for doing so late. Your Open Enrollment Period for Medigap will begin when you’re ready to take advantage of it.

Special Enrollment Period

There’s no guarantee that you’ll be able to enroll in Medigap outside of the Open Enrollment Period. Nonetheless, if you have a “qualifying event,” you may sign up during a Special Enrollment Period. A qualifying event is a change in your circumstances that would affect your ability to enroll in Medigap. Here are some examples of qualifying events:

  • You move to a new state
  • You go from having Medicare Advantage to Original Medicare
  • Your Medicare Advantage Plan stops offering the benefits you need


You may be subject to medical underwriting when you sign up for Medigap Plan A outside of the Open Enrollment Period. Insurance companies utilize medical underwriting to determine whether or not to accept your application and how much to charge you for coverage. People with pre-existing medical issues may be denied coverage or have their Medigap Plan M premiums increased.

How To Enroll In Medigap Plan M?

Enrolling in Medigap Plan M is similar to signing up for other types of health insurance. You’ll need to provide some basic information about yourself, such as your name, address, date of birth, and Social Security number. You may also be asked questions about your health history.


Once you’ve provided the necessary information, you’ll be able to compare Medigap plans and prices from different insurance companies. Keep in mind that not all insurers offer all types of Medigap plans. When you’re ready to choose a plan, you can contact the insurer directly to enroll.

Medigap Plan M Costs

Plan M premiums will vary depending on your insurance company, age, location, tobacco use, and whether you opt for a policy with an annual deductible. The monthly premium for Medigap Plan M in Connecticut in 2022 can range from $227 to $610. Private insurance companies will set their rates for Medigap plans based on any of 3 different methods:

  • Community-rated (or age-rated): Your age doesn’t determine your premium. This may only rise due to inflation or other circumstances. Everyone, despite age, has to pay the same premium.
  • Issue age-rated (or entry-age rated): Your age determines your premium at the time of purchase, but that premium won’t rise as you become older. Inflation or other factors may cause your premium to increase.
  • Attained-age-rated: Your age determines your premium, and that premium may rise as you become older or due to inflation and other circumstances.

The Benefits Of Medigap Plan M Compared To Other Health Insurance Plans

Original Medicare doesn’t cover everything, leaving you with several out-of-pocket costs—for example, Part A or Part B deductibles, which can be expensive. In addition, Original Medicare doesn’t cover copayments for services like doctor’s visits or hospital stays.


Medigap Plan M covers half of Part A deductible and copayments for services like doctor’s visits and hospital stays. That means you’ll have fewer out-of-pocket costs if you need medical care. In addition, Medigap Plan M also covers foreign travel emergency care (up to 80%). Other health insurance plans may not cover this type of care.

Is Medigap Plan M The Best Option For You And Your Family?

Only you can decide if Medigap Plan M is the best option for you and your family. We recommend that you sit down and take the time to look closely at your budget and health care needs. Consider how much you’re willing to pay in premiums and how much you’re likely to need in terms of medical care. Once you’ve done that, you can compare Medigap plans and prices to find the best option for you.


If Medigap Plan M covers most of your needs, it may be a viable option. Every individual’s scenario is unique. There’s no such thing as a one-size-fits-all solution when it comes to health insurance.

Nesso Senior Benefits – Find The Right Health Insurance Plan

At Nesso Senior Benefits, we can help you find the right health insurance plan for your needs. We understand that choosing a health insurance plan can be confusing and overwhelming; that’s why we’re here to help. We’ll sit down with you, ask about your situation, and recommend a few different plans that may be a good fit for you.


Our team is always professional and acts with the highest level of integrity. Plus, everyone in the Nesso Senior Benefits team believes that communication is essential. We’ll be happy to answer any questions you may have through the process. We make sure that our clients get all of the information they need about their Medicare insurance so that they can make informed decisions about their health.


As part of the Nesso Group, we provide guidance to individuals and businesses in various fields. Our services include tax, accounting, wealth, insurance, and more. We strive to deliver the most thorough and holistic advice to our clients to reduce stress and increase success.



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