Medigap Plan M: Medigap Plan M

Plan M is a deductible-sharing plan. It provides variable coverage and has greater out-of-pocket medical costs.

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Cost
Plan premiums vary by individual and geography.
Prior Authorization Required
Qualifications do NOT apply if purchasing during the Medicare Initial Enrollment Period. Your loved one must meet criteria for approval if purchasing at any point after Initial Enrollment.
Provider Referral or Order Required
No

How To Receive

Details on how to apply

  1. Receive services from a provider that is able to bill Medicare.

  2. Ask that the provider bill both Medicare and Medigap.

  3. Review any bills your loved one receives to ensure that both Medicare and Medigap have paid their portions.

    • If either has not paid, ask the provider to resend the bill to them.

    • If both have paid, but you feel that there is an error (i.e., they didn't pay as much as they should have or you have questions), contact Medicare* or the Medigap insurance provider directly.

  4. Remit any remaining costs to the provider that were not covered by Medicare or Medigap.

*For specific billing questions and questions about claims, medical records, or expenses, log into the Medicare account, or call us at 1-800-MEDICARE (1-800-633-4227).

Availability
Only during Initial and Open Medicare Enrollment Periods.

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Plan M is a deductible-sharing plan. It provides variable coverage and has greater out-of-pocket medical costs since it only covers half (50%) of the Part A deductible.

Plan M covers all remaining costs for these Original Medicare benefits: - Medicare Part A coinsurance and hospital costs - Medicare Part B copays/coinsurance - Blood (first 3 pints) - Medicare Part A hospice services - Skilled nursing facility (SNF) costs - 80% of foreign travel emergency

Plan M covers half (50%) of the remaining costs for this Original Medicare benefit: - Medicare Part A deductible

Plan M does not cover any remaining costs for: - Medicare Part B deductible - Medicare Part B excess charges

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