Medigap Plan M is a type of Medicare Supplement Insurance (Medigap) policy that helps cover some out-of-pocket costs not paid by Original Medicare (Part A and Part B).

OVER 65 or on Medicare (under 65 see below)

Key Features of Medigap Plan M:

1. Covers 50% of the Medicare Part A deductible – Unlike some other Medigap plans that fully cover this cost, Plan M only covers half.
2. Covers Medicare Part B coinsurance (20%) – Helps with doctor visits, outpatient care, and durable medical equipment.
3. Covers Medicare Part A coinsurance and hospital costs – Covers an extra 365 days after Medicare benefits are used up.
4. Covers Skilled Nursing Facility (SNF) coinsurance – Helps with extended stays in a skilled nursing facility.
5. Covers emergency foreign travel (80%) – Covers up to $50,000 in lifetime coverage.
6. Does NOT cover the Medicare Part B deductible – You must pay this out-of-pocket.
7. Does NOT cover Medicare Part B excess charges – If a doctor charges more than what Medicare allows, you will have to pay the difference.

Who Might Choose Medigap Plan M?

• Those looking for lower monthly premiums in exchange for sharing the Medicare Part A deductible.
• People who rarely need hospital care, since they would only pay half of the deductible when hospitalized.
• Individuals who don’t see non-Medicare-assigned providers (since it does not cover excess charges).
• Those who travel internationally and need some emergency foreign travel coverage.

How Does Plan M Compare to Other Medigap Plans?

• It is similar to Plan N, but Plan N requires copays for doctor and ER visits, while Plan M does not.
• It is more affordable than Plan F and Plan G, but those plans offer full coverage of the Part A deductible and excess charges.

Got Questions? Call 1-800-MEDIGAP or Compare Medigap Plans

Over 65? or on Medicare?

How Medigap Insurance Works over 65

Medigap, also known as Medicare Supplement Insurance, is private health insurance that helps cover the out-of-pocket costs left by Original Medicare (Part A and Part B).

1. What Does Medigap Cover?

Medigap helps pay for expenses that Medicare doesn’t fully cover, such as:

• Copayments (cost-sharing for doctor visits, hospital stays, etc.)
• Coinsurance (the percentage of costs you pay after Medicare pays its share)
• Deductibles (set amounts you must pay before Medicare starts covering costs)
• Foreign travel emergency coverage (available with some plans)
• Skilled nursing facility (SNF) care coinsurance

Each Medigap plan (A, B, C, D, F, G, K, L, M, and N) offers different levels of coverage. The benefits of each plan are standardized across insurance companies.

2. How Does Medigap Work with Medicare?

• You must have Medicare Part A and Part B to buy a Medigap policy.
• Medicare pays first, covering its portion of approved healthcare services.
• Medigap pays second, covering the remaining costs based on the plan you choose.
• You pay a monthly premium for the Medigap policy in addition to your Medicare Part B premium.
• Medigap only covers one person, so spouses must buy separate policies.

3. What Medigap Does NOT Cover

Medigap policies do not cover:

• Prescription drugs (You need Medicare Part D for that)
• Long-term care (e.g., nursing home stays beyond 100 days)
• Vision or dental care
• Hearing aids
• Private-duty nursing
• Eyeglasses

4. Choosing a Medigap Policy

• Compare plans: Different Medigap plans cover different benefits. For example, Plan F covers everything, while Plan M only covers 50% of the Part A deductible.
• Premium costs vary by provider: Even though Medigap benefits are standardized, different insurance companies charge different premiums.
• Enroll during the Medigap Open Enrollment Period (6 months after you turn 65 and enroll in Part B) to avoid medical underwriting.
• Medigap is not the same as Medicare Advantage (Part C): You cannot have both at the same time.

How does Medicap work under 65 or NO insurance, or on a group or individual plan with a high deductible?

How Medigap Works for Individuals and Families on Group Insurance, Individual Insurance, or ACA Subsidized Plans

Introduction

Healthcare costs continue to rise, and many individuals and families struggle with high out-of-pocket expenses, copayments, and deductibles. While Medicare beneficiaries have the option to supplement their coverage with Medigap (Medicare Supplement Insurance), many people enrolled in group insurance, individual health plans, or Affordable Care Act (ACA) marketplace plans seek similar gap coverage to manage their healthcare costs. This article explores how Medigap functions for Medicare recipients and examines private alternatives for individuals and families needing financial relief from excessive medical expenses.

What is Medigap and How Does It Work?

Medigap is a private health insurance policy designed to cover the gaps left by Original Medicare (Part A and Part B). It helps pay for expenses like:

• Deductibles (amount paid before insurance coverage kicks in)
• Coinsurance (percentage of costs paid out-of-pocket after Medicare covers its portion)
• Copayments (fixed amounts for doctor visits and hospital stays)
• Foreign travel emergency care
• Skilled nursing facility (SNF) coinsurance

Medigap policies are standardized and labeled from Plan A to Plan N, offering different levels of coverage. While Medigap only applies to Medicare beneficiaries, private insurers offer gap-filling alternatives for those under group health insurance, individual plans, or ACA coverage.

Gap Coverage for Individuals & Families with Employer Group Insurance

Many people receive healthcare coverage through employer-sponsored group health insurance, but these plans often include:

• High deductibles that must be met before coverage applies
• Coinsurance and copayments that add to out-of-pocket expenses
• Limited out-of-network coverage

Some employers offer supplemental health insurance options, such as Hospital Indemnity, Critical Illness, or Accident Insurance, which help cover expenses beyond what the primary plan pays. Additionally, individuals may purchase private “Gap” or “Supplemental” insurance plans to assist with unexpected healthcare costs.

How Individual and ACA Marketplace Plan Members Can Use Private Gap Insurance

For individuals purchasing their own private health insurance or those enrolled in an ACA (Obamacare) plan, the challenge remains the same—high deductibles, copays, and coinsurance. Some solutions include:

1. Short-Term Health Insurance with Supplemental Coverage:
   • Covers some out-of-pocket costs but has limitations like pre-existing condition exclusions.
2. Fixed Indemnity Plans:
   • Pays a set dollar amount per day for hospitalization, outpatient care, or physician visits.
3. Critical Illness & Accident Insurance:
   • Provides lump sum payments to help cover high-deductible health plan (HDHP) costs when a major illness or accident occurs.
4. Health Savings Accounts (HSA) with HDHPs:
   • Allows individuals to save pre-tax dollars to cover medical expenses, reducing financial strain.
5. Supplemental Dental & Vision Insurance:
   • Covers expenses not included in ACA or employer-based plans.

Comparing Medigap with Private Supplemental Plans

Feature	Medigap (For Medicare)	Private Supplemental Plans (For Non-Medicare)
Eligibility	Medicare enrollees (65+ or disabled)	Individuals & families under 65
Covers Deductibles?	Yes, depending on plan	Some plans, but limited
Covers Copays?	Yes	Varies by plan
Covers Coinsurance?	Yes	Some plans provide assistance
Covers Prescription Drugs?	No (Separate Part D needed)	Some private plans cover Rx
Covers Hospital Stays?	Yes	Indemnity plans provide daily benefits
International Coverage?	Some plans include 80% foreign emergency coverage	Varies by insurer and policy

Who Should Consider Supplemental Health Insurance?

Individuals and families who should consider supplemental insurance include:

• People with high-deductible ACA plans who need assistance with out-of-pocket costs.
• Self-employed individuals without access to employer group health benefits.
• Families with young children who frequently visit doctors or need urgent care.
• Seniors who retire early and need coverage before they qualify for Medicare.
• People with chronic conditions requiring frequent medical care and specialist visits.

Conclusion

While Medigap is an excellent solution for Medicare beneficiaries, individuals and families who rely on group health insurance, private plans, or ACA coverage can benefit from alternative gap insurance policies. Understanding how these policies work and choosing the right one can help protect against unexpected medical expenses and financial hardship. Whether it’s fixed indemnity plans, critical illness insurance, or employer-sponsored supplements, finding the right gap coverage ensures better financial security and peace of mind