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Understanding Medigap Plan M

Understanding Medigap Plan M

Understanding Medigap Plan M could essentially end up saving you hundreds – or even thousands – of dollars every month on your health care costs. If you are enrolled in Medicare, or if you are about to become a Medicare enrollee, you may find that even though the Medicare program pays a wide array of coverages for hospitalization and other medical services, it can also leave you with a great deal of out-of-pocket expenses.

Because of that, many of those who are Medicare Part A and B participants must either find a way to pay these high expenses or alternatively some may opt to forgo the procedures that they require due to the high cost. The good news is, though, you can get some relief from these expenses by owning a Medicare Supplement plan.

What Does Medigap Plan M Cover?

For those who want just a base plan, Medigap Plan A may be an option to consider. However, there are many other plans to choose from. For example, Medigap Plan M provides much more in term of coverage – which can, in turn, end up providing much more in overall savings. This is especially the case for those who may require more in health care services throughout the year.

The benefits that are offered (in 2016) through Medicare Supplement Plan M include:

  • Medicare Part A hospitalization co-insurance and hospitalization expenses – up to 365 days after Original Medicare benefits have been used up;
  • Medicare Part A hospice co-payment and co-insurance;
  • Medicare Part B co-insurance and co-payment;
  • First 3 pints of blood per year;
  • Medicare Part A skilled nursing facility care co-insurance;
  • Medicare Part A deductible (covered at 50%);
  • Foreign travel emergency coverage – up to plan limits (covered at 80%).

Why Consider Medicare Supplement Plan M Over Other Medigap Plans?

Although Medigap Plan M does not cover everything, it does provide a great deal more than just the base benefits that are offered by Medigap Plan A. For that reason, Medicare Supplement Plan M can be considered as a good middle ground policy for those who are seeking more than just the bare bones minimum, but yet don’t need all of the bells and whistles of Medicare supplement plan F, the most comprehensive policy available – as well as the higher premium that goes along with it.

Just some of these additional benefits over the base Plan A can make Medigap Plan M well worth the additional premium that may be charged. For example, the skilled nursing facility benefit could end up saving many thousands of dollars if this type of care is needed. This is because the co-payment that is required for days 21 through 100 during a skilled nursing facility benefit period (in 2016) is $161 per day.

Therefore, if 100 days of skilled nursing facility care (or more) is required in a benefit period, the out-of-pocket expense for the Medicare enrollee could be near $13,000. ($161 daily co-payment X 80 days = $12,880).

There is also a foreign travel emergency benefit that is offered on Medigap Plan M. Therefore, those who travel outside of the United States – especially with great regularity – may find that this particular Medicare Supplement Plan is quite beneficial.

How Medicare and Its Expenses Work

When the Medicare program was first enacted, it contained just two components. These were Medicare Part A and Part B. This is why today, Part A and B of Medicare are commonly referred to as “Original Medicare.” Now, Medicare has expanded into four parts. These include the following:

  • Part A – Medicare Part A provides coverage for hospitalization services. This can include the care that you receive as a hospital inpatient. Medicare Part A also includes coverage for various types of home health care that you may get following an inpatient hospital stay. Also, there is also some limited coverage through Part A for skilled nursing facility care, and for hospice services.
  • Part B – Medicare Part B consists of medical and doctors’ services. This part of Medicare can help with the cost of things such as outpatient hospital care and emergency room services. Part B of Medicare may also provide coverage for various medical equipment that your doctor orders for you, such as a wheelchair or a walker. Also, this part of Medicare may also cover preventive care such as vaccinations that are received for pneumonia and the flu.
  • Part C – Part C of Medicare is also referred to as Medicare Advantage. This is not so much a separate component of Medicare, but rather an alternate way of actually receiving your Medicare Part A and Part B coverage. Medicare Advantage plans must offer all of the benefits that Medicare Part A and Part B provide – and these plans will usually provide additional coverage as well, such as dental, vision, and / or wellness benefits. Often, prescription drug coverage is also included within a Medicare Advantage plan. Medicare Advantage plans are offered via private insurance companies. Many of these plans provide benefits in an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization) format. This means that an enrollee may have to choose their provider(s) from a certain network. In some cases, an enrollee may use and out-of-network provider, but the cost will be more.
  • Part D – Medicare Part D offers prescription drug coverage. Those who are enrolled in Original Medicare (Medicare Part A and Part B) can purchase a Part D plan if they wish to also have prescription drug benefits. These plans are also offered via private insurance companies. Because of that, the coverage – as well as the premium amounts – can differ from plan to plan.

If you are enrolled in Medicare Part A and B, you will likely find that there are many “gaps” in coverage. These often will include the deductibles, coinsurance, and / or copayments that you are required to pay out-of-pocket. In some cases, these expenses can add up. In 2016, the Part A and B out-of-pocket expenses include the following:

Medicare Part A hospital inpatient deductible and coinsurance:

  • $1,288 deductible for each benefit period
  • Days 1 – 60: $0 coinsurance for each benefit period
  • Days 61 – 90: $322 coinsurance per day of each benefit period
  • Days 91 and beyond: $644 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs

Medicare Part B deductible and coinsurance:

  • Deductible of $166
  • After the deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor’s services (including most doctor’s services while you are a hospital inpatient), outpatient therapy, and durable medical equipment.

What is Medicare Supplement Insurance?

Although there are many gaps in Medicare’s coverage, there is a way to help in combating these costs. This can be done by purchasing a Medicare Supplement – or “Medigap” – insurance plan.

Medicare Supplement insurance was specifically designed to help cover some or all of these charges – and some Medicare Supplement plans will even pay for additional coverage that is not provided by Medicare, such as foreign travel benefits.

How Does Medicare Supplement Insurance Coverage Work?

Medicare Supplement offers a wide range of options. Today, there are ten different plans. Each of these plans are named after a letter of the alphabet – beginning with Plan A. This Medigap plan provides the most basic set of “core” benefits. All insurance companies that offer Medicare Supplement insurance must offer Plan A if they provide any other plans – and, most of the Medicare Supplement insurance policies must include this basic set of core benefits in addition to the other coverage that they provide.

The base benefits that are offered by Plan A (in 2016) include the following:

  • Medicare Part A coinsurance and hospital expenses, up to an additional 365 days after the Medicare benefits have expired;
  • Medicare Part B copayment or coinsurance;
  • First 3 pints of blood;
  • Medicare Part A deductible.

All of the Medicare Supplement plans that are sold are required to offer the same, identical benefits on plans of the same letter. What this means is that all Medigap Plan M’s that are sold – no matter where they are purchased – must have the very same coverage, regardless of the insurer that offers it.

However, the insurance companies can charge different premium prices for the coverage. With that in mind, it is important to shop and compare prior to purchasing your Medicare Supplement insurance, because the premium price that you pay could differ – in some cases substantially – from one insurance company to another.

Factors to Consider When Choosing a Medicare Supplement Insurance Policy

There are some key factors to consider before enrolling in any Medicare Supplement insurance policy. Doing so can help you to ensure that you are getting into the right plan for you, based on your specific needs. It can also help you to save on the premium amount that you pay for your Medigap coverage.

First, taking account of your particular health care needs during the year – along with the services that are important to you – will be helpful in narrowing down the proper plan. If you are married, and your spouse is also eligible for Medicare Supplement coverage, this will also be important to do for him or her as well.

Also, you should factor in the amount that you can comfortably afford to pay in Medicare Supplement insurance premiums each year as it relates to the potential amount that you can save in Medicare Part A and B out-of-pocket expenses.

Once you have narrowed down the Medicare Supplement plan that is right for you, it is also wise to compare several insurance carriers’ policies. For example, if you plan to purchase Medigap Plan M, then be sure to compare at least three Medigap Plan M policies and the premiums before making your purchase, as this could save you a substantial amount in premium.

Who is Eligible to Purchase Medicare Supplement Coverage?

You should also make sure that you are eligible to purchase a Medigap plan. This is because not everyone can do so. Only those who are age 65 and over, and who are enrolled in Medicare Part A and B are eligible. So, if you are enrolled in Medicare Advantage, you cannot also have Medicare Supplement insurance.

When Can You Purchase a Medicare Supplement Plan?

The best time to purchase a Medicare Supplement insurance policy is during your open enrollment period. This is the time in which you turn age 65, and you have also enrolled in Medicare Part B. This period lasts for six months.

The reason that your open enrollment period is the best time to also enroll in Medicare Supplement insurance coverage is that you cannot be turned down for a policy – even if you have an adverse health condition. If, however, you wait to apply until your open enrollment period has expired, you will not have this same guarantee.

Where Can You Get the Best Premiums on Medigap Plan M?

In seeking the best premiums on Medigap Plan M, shopping with a company or agency that has access to multiple carriers can help. We work with many of the top Medicare Supplement insurers, and we can assist you with getting all of the information that you need. When you are ready to move forward, just fill in the form on this page.

If you have any additional questions regarding Medigap Plan M – or even if you just simply want to know more about Medicare Supplement Insurance – please feel free to contact us directly. We can be reached toll-free by calling 800-376-0824. We understand that there are a lot of variables when it comes to Medicare Supplement. But we can walk you through all of the important details. So, contact us today – we’re here to help.

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