Plan M is similar to Plan D but only pays half of the Part A deductible. Niche plan with limited availability.
Best for
- Beneficiaries in regions where Plan M is competitively priced
Watch out for
Niche availability - not all carriers offer it.
What Plan M covers
- Part A coinsurance & 365 extra hospital daysCovered in full
- Part B coinsurance or copaymentCovered in full
- Blood (first 3 pints)Covered in full
- Part A hospice coinsurance / copayCovered in full
- Skilled nursing facility coinsuranceCovered in full
- Part A deductible50% covered
- Part B deductibleNot covered
- Part B excess chargesNot covered
- Foreign travel emergency (up to plan limits)Covered in full
Compare to other Medigap plans
- Plan AThe minimum-coverage Medigap plan - basic benefits only.
- Plan BPlan A plus the Part A deductible.
- Plan CComprehensive coverage - closed to anyone newly eligible after Jan 1, 2020.
- Plan DPlan G minus Part B excess. Modest savings, modest reduction in benefit.
- Plan FThe 'everything' plan - closed to newly eligible after Jan 1, 2020.
- Plan GToday's most popular Medigap plan - comprehensive coverage minus only Part B deductible.
- Plan KLower premium, partial coverage with out-of-pocket cap.
- Plan LLike Plan K but covers more - 75% of most cost-sharing.
- Plan NLower premium than Plan G in exchange for office and ER copays.
What Makes Medigap Plan M Different?
Plan M is a quiet corner of the Medigap lineup. It looks a lot like the richer plans, with one change. You and the plan split the Part A hospital deductible down the middle.
That single change is how Plan M trims your premium. Everything else on the benefit chart stays generous, including travel and skilled nursing care. There is no network, so any provider who takes Medicare can treat you.
What Plan M covers in full
Part A hospital coinsurance
Your daily hospital coinsurance, plus 365 extra hospital days after Medicare benefits run out.
Part B coinsurance
Your share of doctor visits, labs, imaging, and other outpatient care, with no visit copays.
Skilled nursing coinsurance
The daily coinsurance for a covered nursing facility stay that follows a qualifying hospital stay.
Blood and hospice
The first three pints of blood each year, plus your share of hospice drugs and respite care.
Foreign travel emergency
Emergency care outside the United States, up to the limits printed in your policy.
The short version
Plan M covers half the hospital deductible instead of all of it. It also leaves you the yearly Part B deductible and any Part B excess charges.
What Does Plan M Leave You to Pay?
- Half of the Part A deductible, owed for each benefit period that includes a hospital stay.
- The yearly Part B deductible, paid once each calendar year.
- Part B excess charges, which a small number of California providers may bill.
- Prescription drugs, routine dental, vision, and hearing care, none of which Medigap covers.
- Long-term custodial care, such as ongoing help with bathing or dressing.
A benefit period is not a calendar year
The Part A deductible resets by benefit period, not by year. A benefit period starts when you enter a hospital and ends after 60 days out of inpatient care. Two separate stays far apart can each trigger the deductible, and on Plan M you would owe half of it twice.
Drug coverage is separate
No Medigap plan includes prescriptions. Plan M members add a stand-alone Part D plan. Part D now has a yearly cap on out-of-pocket drug costs, and that cap changes each year.
Who Is Plan M Genuinely a Good Fit For?
Who this is for
Plan M can fit you if:
- A carrier near you prices Plan M clearly below Plan G or Plan N.
- You want full outpatient coverage without any visit copays.
- You expect few hospital stays and can cover half a deductible.
- You still want travel coverage and skilled nursing protection.
- You prefer one large possible bill over many small ones.
Here is the honest tradeoff, and it is mostly about the market. Plan M is a niche plan, and many carriers simply do not sell it. When few carriers compete, the premium discount can shrink or disappear.
Always price Plan M against the alternatives
Plan M only makes sense if the savings are real. If Plan G costs about the same in your ZIP code, take the fuller coverage. We check that comparison before recommending Plan M to anyone.
How Does Plan M Compare to Plan D?
Plan D is the closest relative. The two are identical on every line but one. Plan D pays the whole Part A deductible, and Plan M pays half of it.
Plan M vs. Plan D at a glance
Plan M
Full outpatient benefits with a shared hospital deductible.
- Monthly premium
- Usually lower of the two
- Part A deductible
- Plan pays 50 percent
- Part A hospital coinsurance
- Covered in full
- Part B coinsurance
- Covered in full, no copays
- Part B deductible
- You pay it once a year
- Part B excess charges
- Not covered
- Foreign travel emergency
- Covered to plan limits
- Best for
- People who expect very few hospital stays.
Plan D
The same benefits with the hospital deductible fully covered.
- Monthly premium
- Usually higher of the two
- Part A deductible
- Covered in full
- Part A hospital coinsurance
- Covered in full
- Part B coinsurance
- Covered in full, no copays
- Part B deductible
- You pay it once a year
- Part B excess charges
- Not covered
- Foreign travel emergency
- Covered to plan limits
- Best for
- People who want hospital costs fully handled.
The decision is a simple wager. If the yearly premium savings on Plan M is larger than half a hospital deductible, Plan M wins in a healthy year. If a hospital stay happens, Plan D or Plan G looks better.
How Do California's Birthday Rule and Trial Rights Work?
California gives Medigap members a yearly window to change carriers without health questions. It is known as the birthday rule, and few states offer anything like it.
- The window. It opens on your birthday each year and runs for 60 days.
- The limit. You may move to the same letter with a different carrier, or to lesser benefits. Moving up to a richer letter is not allowed.
- The catch for Plan M. Few carriers sell it, so a same-letter switch may have only one or two options.
- The timing. Ask for quotes about two months early, and keep your policy until the new one is issued.
Trial rights are separate and come from federal law. They protect people who tried Medicare Advantage and want Original Medicare back. Both versions are guaranteed-issue rights, so no underwriting applies.
- You joined Medicare Advantage when you first turned 65. Leave within the first 12 months, and you may buy any Medigap plan sold in California.
- You dropped Medigap to try Medicare Advantage for the first time. Return within 12 months, and you may reclaim your old policy. If it is no longer sold, Plan M is on the list you may buy.
Mark the window
Nobody sends a reminder when these windows open or close. We track each client's birthday window as part of their annual review.
What Does Underwriting Look Like Outside a Guaranteed-Issue Window?
Medigap open enrollment is your cleanest path. It runs six months from the month you turn 65 and have Part B. During it, carriers must accept you at their standard rate.
Outside that window, and without a guaranteed-issue right, a carrier may review your health first. That review is medical underwriting, and approval is never promised.
- Health questions about conditions treated in the past two to five years.
- A prescription history check, pulled electronically in minutes.
- Height and weight, measured against the carrier's build chart.
- Pending care, such as a scheduled surgery or a test still awaiting results.
- A short phone interview at some carriers, to confirm your answers.
Underwriting bites harder on a niche plan
If only a couple of carriers sell Plan M in California, a single decline can close the door. Apply while you are healthy, keep your current coverage until the new policy is issued, and let your agent check each carrier's rules first.
Is Plan M Even Available Near You?
That is the first question, not the last. A plan nobody sells cannot save you money. Benefits are standardized by federal law, so access, price, and service are the only variables.
- Which carriers file Plan M for your age and ZIP code in California.
- The real premium gap between Plan M, Plan D, Plan N, and Plan G.
- Rate increase history, which can run higher on low-volume plans.
- Household and payment discounts, which several carriers offer.
Is Plan M worth it for you?
Harmony SoCal Insurance Services is an independent multi-carrier agency at 2135 N Pami Circle, Orange, CA 92867. Call (714) 922-0043 or request a review. California license #0718082. Meet in person, by video, or by phone, in English and Spanish, with Korean, Mandarin, and Vietnamese available. Comparing letters? Start at the Medigap overview.