Medigap Plan M 2026: Coverage, Costs, and Whether Plan M Is Worth It
Medigap Plan M 2026: Coverage, Costs, and Whether Plan M Is Worth It
TL;DR Quick Answer
Medigap Plan M is a cost-sharing supplement that covers 100% of Medicare Part A expenses (hospital, hospice, deductible, skilled nursing) but only 50% of Medicare Part B coinsurance. It does not cover the Part B deductible ($257 in 2026), Part B excess charges, or foreign travel emergency. Plan M premiums typically run 20-30% lower than Plan G, making it a niche option for beneficiaries who want strong hospital protection with lower monthly costs and minimal doctor visits.
Key Takeaways
- Plan M splits coverage between Part A and Part B — you get full hospital coverage but only half of outpatient cost-sharing, which is unique among Medigap plans
- Monthly premiums are 20-30% cheaper than Plan G — expect $90-$160/month depending on age, state, and tobacco use
- Plan M does NOT cover the Part B deductible ($257/year), Part B excess charges, or foreign travel emergency — these gaps can add up if you see specialists frequently
- Plan M is best for healthy seniors with low outpatient utilization — if you rarely visit doctors, the premium savings can outweigh the 50% coinsurance risk
- Plan M is one of the least-purchased Medigap plans nationally — fewer insurers offer it, which can mean less price competition in some states
- Plan M is not the same as Plan N — Plan N uses flat copays ($20 doctor, $50 ER) while Plan M uses percentage-based cost-sharing (50% of Part B coinsurance)
What Medigap Plan M Covers: Full Benefit Breakdown
Plan M is one of ten standardized Medigap plans available in most states. It occupies a unique middle ground: full Part A protection paired with partial Part B coverage. Here is every benefit Plan M provides.
Plan M Benefit Table
| Medicare Benefit | Plan M Coverage | What You Pay |
|---|---|---|
| Part A coinsurance & hospital costs (days 1-60) | ✅ 100% | $0 |
| Part A deductible ($1,676 in 2026) | ✅ 100% | $0 |
| Part A hospice coinsurance | ✅ 100% | $0 |
| Skilled nursing facility coinsurance (days 21-100) | ✅ 100% | $0 |
| First 3 pints of blood | ✅ 100% | $0 |
| Part B coinsurance (20% of Medicare-approved amounts) | ✅ 50% only | 50% of coinsurance |
| Part B deductible ($257/year in 2026) | ❌ Not covered | Full $257/year |
| Part B excess charges (up to 15%) | ❌ Not covered | Full excess amount |
| Foreign travel emergency (80%, lifetime max $50,000) | ❌ Not covered | 100% of costs |
Understanding the 50% Part B Coinsurance Rule
This is the defining feature of Plan M and the most important thing to understand before enrolling.
Standard Medicare Part B covers 80% of Medicare-approved outpatient costs. You are responsible for the remaining 20% coinsurance. With most Medigap plans (like Plan G), the supplement pays that entire 20%. With Plan M, the supplement pays half of that 20% — meaning Plan M covers 10% and you cover 10%.
Example: If you have a $1,000 outpatient procedure:
- Medicare Part B pays: $800 (80%)
- Plan M pays: $100 (50% of your 20% coinsurance)
- You pay: $100 (the other 50% of coinsurance) + any remaining Part B deductible
Compare this to Plan G, where you would pay $0 for this procedure (after meeting the Part B deductible).
What Plan M Does NOT Cover: Gaps vs Plan G
Plan M has four significant gaps compared to comprehensive plans like Plan G:
| Coverage Gap | Plan M | Plan G | Annual Cost Impact |
|---|---|---|---|
| Part B coinsurance (full) | 50% only | 100% | $200-$2,000+ depending on usage |
| Part B deductible ($257) | ❌ | ❌ (you pay) | Same for both: $257 |
| Part B excess charges | ❌ | ✅ 100% | $0-$500+ per specialist visit |
| Foreign travel emergency | ❌ | ✅ 80% up to $50k | Varies (critical for travelers) |
The Part B deductible gap is identical between Plan M and Plan G — neither covers it. The real differences are the 50% coinsurance split, lack of excess charge protection, and no foreign travel coverage.
Plan M Costs and Premiums for 2026
Average Monthly Premiums by Age
Plan M premiums are age-rated, community-rated, or issue-age-rated depending on your state’s pricing method. The following table shows average monthly premiums for a non-tobacco female at common enrollment ages.
| Age | Average Monthly Premium | Annual Cost |
|---|---|---|
| 65 | $95-$130 | $1,140-$1,560 |
| 70 | $105-$145 | $1,260-$1,740 |
| 75 | $120-$165 | $1,440-$1,980 |
| 80 | $135-$185 | $1,620-$2,220 |
| 85 | $150-$210 | $1,800-$2,520 |
Tobacco surcharge: Add 10-20% to all premiums above if you use tobacco products.
Average Monthly Premiums by State (Age 65, Non-Tobacco)
| State | Average Premium | Notes |
|---|---|---|
| Florida | $125-$155 | High demand, many carriers |
| Texas | $100-$130 | Competitive market |
| California | $110-$140 | Community-rated state |
| New York | $130-$160 | Community-rated, guaranteed issue |
| Ohio | $95-$120 | Lower cost of living |
| Pennsylvania | $100-$125 | Mixed rating methods |
| North Carolina | $95-$125 | Issuer-rated |
| Illinois | $100-$130 | Standard market |
Premiums vary widely by zip code, carrier, and underwriting method. Use our Medigap comparison calculator to get personalized estimates.
Total Annual Cost Estimate (Age 65, Moderate Health)
| Cost Component | Plan M | Plan G | Plan N |
|---|---|---|---|
| Annual premium | $1,320 | $1,800 | $1,440 |
| Part B deductible | $257 | $257 | $257 |
| Part B coinsurance (your share) | $300-$600 | $0 | $0 (copays: $100-$200) |
| Part B excess charges | $0-$200 | $0 | $0-$200 |
| Foreign travel (if applicable) | Full cost | Covered 80% | Covered 80% |
| Total estimated annual cost | $1,877-$2,377 | $2,057 | $1,797-$2,097 |
As you can see, Plan M’s total annual cost can be comparable to Plan G once you factor in the 50% coinsurance you pay out of pocket — especially if you have moderate or high outpatient usage.
Plan M vs Plan G Comparison
Plan G is the gold standard for Medigap coverage. Here is how Plan M stacks up.
| Feature | Plan M | Plan G |
|---|---|---|
| Part A coinsurance | ✅ 100% | ✅ 100% |
| Part A deductible | ✅ 100% | ✅ 100% |
| Part B coinsurance | ✅ 50% only | ✅ 100% |
| Part B deductible | ❌ | ❌ |
| Part B excess charges | ❌ | ✅ 100% |
| Foreign travel emergency | ❌ | ✅ 80% up to $50k |
| First 3 pints of blood | ✅ | ✅ |
| SNF coinsurance | ✅ 100% | ✅ 100% |
| Monthly premium (age 65) | $95-$130 | $130-$180 |
| Annual out-of-pocket risk | Moderate ($500-$2,000+) | Low ($257 only) |
Verdict: Plan G wins for almost everyone. The 20-30% premium savings with Plan M rarely compensates for the 50% coinsurance exposure, excess charge risk, and lack of travel coverage. Plan M only makes sense if your outpatient costs are extremely low.
For a deeper comparison of two popular alternatives, see our Plan G vs Plan N comparison guide.
Plan M vs Plan N Comparison
Plan N is the most popular cost-sharing Medigap plan. Both Plan M and Plan N trade lower premiums for some out-of-pocket costs, but they do it differently.
| Feature | Plan M | Plan N |
|---|---|---|
| Part B cost-sharing model | 50% of coinsurance | $20 copay per visit |
| ER visit cost | 50% of coinsurance | $50 copay (waived if admitted) |
| Part B excess charges | ❌ | ❌ |
| Foreign travel emergency | ❌ | ✅ 80% up to $50k |
| Monthly premium (age 65) | $95-$130 | $100-$140 |
| Predictability | Percentage-based (variable) | Flat copay (predictable) |
Verdict: Plan N is generally better than Plan M for most people. Plan N’s flat copays make costs predictable ($20/visit), while Plan M’s percentage-based sharing means your costs scale with the price of services — a $500 procedure and a $5,000 procedure cost very different amounts under Plan M.
Additionally, Plan N includes foreign travel emergency coverage that Plan M lacks entirely.
Learn more about how Plan N copays work in our Plan N copay break-even analysis.
Plan M vs High-Deductible Plan G
High-Deductible Plan G (HDG) is another option for beneficiaries who want lower premiums. Here is how it compares to Plan M.
| Feature | Plan M | High-Deductible Plan G |
|---|---|---|
| 2026 deductible | $0 (but 50% Part B sharing) | $2,800 annual deductible |
| Part A coverage | ✅ 100% from day 1 | Subject to deductible |
| Part B coverage | 50% of coinsurance | 100% after deductible met |
| Monthly premium (age 65) | $95-$130 | $60-$90 |
| Part B excess charges | ❌ | ✅ 100% (after deductible) |
| Foreign travel emergency | ❌ | ✅ 80% up to $50k (after deductible) |
| Maximum out-of-pocket | Unlimited (but capped at 50% of Part B) | $2,800 deductible, then full coverage |
Verdict: High-Deductible Plan G offers better catastrophic protection once you meet the $2,800 deductible — after that, everything is covered at 100%. Plan M never has a deductible but also never provides full Part B coverage. If your annual outpatient spending is low (under ~$2,800), HDG premiums are lower and the deductible may never matter. If your spending is moderate ($2,000-$5,000), Plan M’s 50% sharing could cost you more than HDG’s deductible.
For a detailed cost analysis, read our High-Deductible Plan G vs Standard Plan G break-even guide.
Who Should Consider Plan M
Plan M is a niche product that works well for a specific profile:
- Very healthy seniors with minimal doctor visits — if you see a doctor once or twice a year, the 50% coinsurance exposure is minimal ($20-$60 total)
- Those primarily concerned about hospital costs — Plan M provides 100% Part A coverage including the $1,676 Part A deductible
- Budget-conscious beneficiaries who want some supplement protection — premiums are lower than Plan G or Plan N while still providing a safety net
- People who don’t travel internationally — the lack of foreign travel emergency coverage won’t matter if you stay in the US
Ideal Candidate Profile
A 68-year-old retiree in Ohio who:
- Visits their primary care doctor twice a year for checkups
- Has no chronic conditions requiring frequent specialist visits
- Wants hospital coverage but can’t justify Plan G’s $150/month premium
- Doesn’t travel outside the United States
- Has an HSA or savings to cover the 50% Part B coinsurance if needed
Who Should Avoid Plan M
Plan M is a poor choice for several common situations:
- Anyone with chronic health conditions — diabetes, heart disease, cancer, or autoimmune disorders mean frequent doctor visits and expensive outpatient procedures where 50% coinsurance adds up fast
- People who see specialists regularly — specialist visits cost more ($150-$400+), and 50% of that coinsurance is significantly more than Plan N’s flat $20 copay
- International travelers — no foreign travel emergency coverage means you’re completely unprotected abroad
- Those who want predictable costs — percentage-based cost-sharing makes budgeting harder than flat copays (Plan N) or full coverage (Plan G)
- Beneficiaries in states with excess charge providers — if doctors in your area commonly charge the 15% Part B excess, you’ll pay that entire amount yourself
- Anyone who prefers comprehensive peace of mind — Plan M’s gaps create financial anxiety for people who want their supplement to cover everything
How to Enroll in Plan M
Step 1: Confirm Your Eligibility
You can buy Plan M if you:
- Are enrolled in Medicare Parts A and B
- Are age 65 or older (or under 65 with a disability in some states)
- Live in a state where Plan M is available (most states, but not Massachusetts, Minnesota, or Wisconsin which have their own standardized plans)
Step 2: Use Your Medigap Open Enrollment Period
The best time to enroll is during your 6-month Medigap Open Enrollment Period, which starts the month you turn 65 and are enrolled in Part B. During this window:
- You have guaranteed issue rights — no medical underwriting required
- No pre-existing condition exclusions
- You get the best available rates
If you miss this window, you may face medical underwriting and could be denied coverage or charged higher rates.
Step 3: Compare Carriers
Plan M is standardized — the benefits are identical regardless of which insurance company sells it. The only difference is price. Get quotes from at least 3-5 carriers:
- AARP/UnitedHealthcare
- Blue Cross Blue Shield (state plans vary)
- Mutual of Omaha
- Cigna
- Aetna
Step 4: Apply
You can apply:
- Directly through the insurance company
- Through a licensed insurance agent (at no extra cost to you)
- Through your state’s health insurance marketplace (if offered)
For a complete enrollment checklist, see our Medicare supplement application documents guide.
Step 5: Review Annually
Unlike Medicare Advantage, Medigap plans do not have annual enrollment periods. However, you should review your premium each year. If your Plan M rate increases significantly, you may want to shop for a different plan during a guaranteed issue opportunity.
State-Specific Notes for Plan M
States with Birthday Rules
Some states offer annual “birthday rules” that let you switch Medigap plans without medical underwriting:
| State | Birthday Rule Details |
|---|---|
| California | Switch to same or lesser-premium plan within 30 days of your birthday |
| Oregon | Switch to same or lesser-benefit plan within 30 days of your birthday |
| Idaho | Switch to any plan within 30 days of your birthday |
If you start with Plan M and later decide you need more coverage (like Plan G), these birthday rules can be a pathway — but only in these specific states.
For a full breakdown, see our Medicare Supplement Birthday Rule by State guide.
Community-Rated States
In community-rated states (New York, Vermont, Maine), everyone pays the same premium regardless of age. This can make Plan M relatively more or less attractive compared to issue-age-rated states.
States with Different Standardized Plans
Plan M is not available in:
- Massachusetts — uses its own standardized plan types
- Minnesota — uses its own standardized plan types
- Wisconsin — uses its own standardized plan types
If you live in one of these states, you’ll need to compare their local plan equivalents.
Check our Medicare Supplement Plans Comparison by State for state-specific details.
Plan M vs Other Medigap Plans: Summary Matrix
| Feature | Plan M | Plan G | Plan N | HD Plan G | Plan K | Plan L |
|---|---|---|---|---|---|---|
| Part A coinsurance | ✅ 100% | ✅ 100% | ✅ 100% | After ded. | 50% | 75% |
| Part A deductible | ✅ | ✅ | ✅ | After ded. | 50% | 75% |
| Part B coinsurance | 50% | ✅ 100% | Copays | After ded. | 50% | 75% |
| Part B deductible | ❌ | ❌ | ❌ | After ded. | ❌ | ❌ |
| Excess charges | ❌ | ✅ | ❌ | ✅ | ❌ | ❌ |
| Foreign travel | ❌ | ✅ | ✅ | ✅ | ❌ | ❌ |
| Out-of-pocket cap | ❌ | ❌ | ❌ | $2,800 | $6,940 | $3,470 |
| Premium (age 65) | $95-$130 | $130-$180 | $100-$140 | $60-$90 | $70-$100 | $85-$115 |
For help finding the right plan for your specific situation, see our Best Medigap Plans by Health Profile 2026.
Frequently Asked Questions About Medigap Plan M
Does Medigap Plan M cover the Part B deductible?
No. Plan M does not cover the Medicare Part B deductible, which is $257 in 2026. You pay this amount out of pocket before Medicare Part B begins covering your outpatient services. This is the same as Plan G, Plan N, and most other Medigap plans — only Plan C and Plan F cover the Part B deductible, and both are unavailable to people newly eligible for Medicare after January 1, 2020.
How much does Plan M cost per month compared to Plan G?
Plan M typically costs $30-$50 less per month than Plan G for a 65-year-old non-tobacco applicant. For example, if Plan G costs $150/month in your area, Plan M might cost $100-$120/month. However, the 50% Part B coinsurance you pay under Plan M can easily erase those savings if you have even moderate outpatient medical expenses.
Can I switch from Plan M to Plan G later?
You can apply to switch from Plan M to Plan G at any time, but outside of your Medigap Open Enrollment Period or a guaranteed issue right, you will likely need to pass medical underwriting. If you have developed health conditions since enrolling in Plan M, you could be denied Plan G or charged a higher rate. Residents of California, Oregon, and Idaho can use their state’s birthday rule to switch plans annually without underwriting.
Does Plan M cover Part B excess charges from specialists?
No. Plan M does not cover Medicare Part B excess charges. If your doctor charges up to 15% more than the Medicare-approved amount (the “limiting charge”), you pay the entire excess amount yourself. This is a meaningful gap if you see specialists who don’t accept Medicare assignment. Plan G and High-Deductible Plan G cover excess charges in full.
Is Medigap Plan M still available to new Medicare beneficiaries?
Yes. Unlike Plan F and Plan C (which were closed to new beneficiaries in 2020), Plan M remains available to anyone newly eligible for Medicare. However, it is one of the less commonly purchased Medigap plans, and not every insurance carrier offers it in every state. You may need to shop around to find a Plan M policy in your area.
Does Plan M cover foreign travel emergencies?
No. Plan M does not include foreign travel emergency coverage. If you travel outside the United States, you will have no supplemental coverage for emergency medical care. Plan G, Plan N, and High-Deductible Plan G all cover 80% of foreign travel emergency costs up to a $50,000 lifetime limit. If international travel is part of your retirement plans, consider a travel insurance policy or a different Medigap plan.
How is Plan M different from Plan N for doctor visit costs?
Plan M charges you 50% of the Part B coinsurance for each outpatient service, which means your cost varies based on the service price. Plan N charges a flat $20 copay per doctor visit. For a typical $200 office visit, Plan M costs you $20 (50% of the 20% coinsurance), making it comparable to Plan N. But for a $2,000 outpatient procedure, Plan M costs you $200 while Plan N’s copay remains $20. Plan N is more predictable and usually less expensive for beneficiaries with moderate to high outpatient usage.
What happens if I need expensive outpatient surgery under Plan M?
Under Plan M, you would pay 50% of the 20% Part B coinsurance for outpatient surgery. For a $10,000 outpatient procedure, Medicare pays $8,000 (80%), Plan M pays $1,000 (50% of your $2,000 coinsurance), and you pay $1,000 out of pocket. Under Plan G, you would pay $0 for the same procedure (after the Part B deductible). This illustrates why Plan M is best suited for people with minimal expected outpatient costs.
The Bottom Line: Is Plan M Worth It in 2026?
For most Medicare beneficiaries, Plan M is not the best value. The 20-30% premium savings over Plan G is quickly consumed by the 50% Part B coinsurance exposure, and the lack of foreign travel coverage and excess charge protection are significant drawbacks.
Plan M makes sense only if all of the following are true:
- You visit doctors fewer than 2-3 times per year
- You have no chronic conditions requiring ongoing treatment
- You don’t travel internationally
- You want lower premiums but still want full hospital protection
- You can’t qualify for or afford High-Deductible Plan G
If you’re deciding between Medigap plans, the most common recommendation is to compare Plan G and Plan N rather than Plan M. Both offer better value for most health profiles.
Plan Your Medigap Costs
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Related Guides
- Medigap Plan G vs Plan N: Which Is Better in 2026?
- High-Deductible Plan G vs Standard Plan G: Break-Even Analysis
- Medicare Supplement Plans Comparison by State
- Best Medigap Plans by Health Profile 2026
- Plan G vs Plan N Calculator
- Medicare Supplement Birthday Rule by State
- Medicare Supplement Application Documents Checklist