2026 Medicare Supplement Plan M: Shared Deductible, Covered Costs & Exclusions

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Understanding Medicare Supplement Plan M

Medicare Supplement Plan M is one of eight standardized Medicare Supplement Insurance plans that are available for purchase (in all states except for Massachusetts, Minnesota, and Wisconsin, as they have their own standardized Medicare Supplement plans). These plans are also known as Medigap since they fill in the coverage gaps left by Original Medicare Parts A and B. Medicare Supplement Plan M is sometimes referred to as the “shared deductible plan” and is one of the more popular supplement plans because it often has low monthly premiums with a decent amount of coverage..

What does Medicare Supplement Plan M cover?

Supplement Plan M covers 50% of your Original Medicare Part A deductible — the hospitalization deductible. In 2026, the deductible is $1,736, so you would be responsible for paying $868 toward annual out-of-pocket expenses for services, including inpatient hospital care, care in a skilled nursing facility, hospice care, and some home health services. With Plan M, you are also responsible for paying the entire annual outpatient deductible..

Covered

Hospital Expenses: Once Original Medicare Part A benefits are used up, Plan M covers 100% of Original Medicare Part A coinsurance and hospital costs for up to 365 days.

Medical Expenses: Original Medicare Part B coinsurance or copayments.

Transfusions: The first three pints of blood you receive in a medical procedure.

Hospice Care: Pays 100% of Original Medicare Part A hospice care coinsurance or copayments.

Skilled Nursing: Pays 100% of facility care coinsurance.

Additional Hospitalization Expenses: Pays 50% of the Original Medicare Part A deductible.

Foreign Travel Medical Emergencies: Pays 80% of foreign travel emergency medical coverage (up to plan limits).

Not Covered

Part B Deductible: The Medicare Part B deductible for 2026 is $283. After the deductible is met, you pay 20% of the Medicare-approved amount (this is the amount a doctor or supplier that accepts assignment can be paid in Original Medicare) for most doctor services, outpatient therapy, and durable medical equipment.¹

Part B Excess Charges: Providers who don’t accept Medicare assignments may charge up to 15% more than what Original Medicare is willing to pay, known as Part B excess charges. Medicare assignment is the Medicare-approved cost for a particular medical service. Medicare assignment is accepted by Medicare-approved providers.

Prescription Drugs: Medigap Plan M does not cover prescription drugs. However, you can buy an additional Medicare Prescription Drug plan to cover prescription drug costs.

Who can benefit from this type of supplement plan?

Medicare Supplement Plan M can help cover out-of-pocket costs that Original Medicare doesn’t cover. Whether Medicare Supplement Plan M is right for you will depend on your unique coverage needs.

Advantages of Medicare Supplement Plan M

Reduced monthly premiums

Disadvantages of Medicare Supplement Plan M

It covers only 50% of your Original Medicare Part A deductible
You’ll be responsible for paying the entire annual outpatient deductible
No out-of-pocket limit

Medicare Supplement Plan M Costs

Monthly premiums are set by the private insurance companies that offer Medicare Supplement Insurance and are based on age, health status, gender, and various other factors. Depending on these factors, including location, insurance companies may charge different premiums for the same Medicare Supplement Plan M.

That’s why it is in your best interest to shop around to ensure you are paying the lowest amount possible for your Medigap coverage. Companies may not cancel your coverage unless you don’t pay the plan premium, you weren’t truthful on the application, or the Medigap insurance company becomes bankrupt or insolvent.

With Plan M covering only 50% of your Medicare Part A deductible, you would be responsible for paying $868, as the deductible is $1,736 in 2026, toward your annual out-of-pocket expenses.

How Pricing Works For This Plan

Pricing for Medicare Supplement Plan M varies by company. Medigap policies can be priced in three ways: community-rated, issue-age-rated, and attained-age-rated.

Community-Rated: Generally, the same monthly premium is charged to everyone who has the Medigap plan, regardless of age. Premiums may go up because of inflation and other factors, but not because of your age.
Issue-Age-Rated: The premium is based on the age you were when you bought the Medigap plan. Premiums are lowered for people who buy at a younger age and won’t change when you get older. Premiums may go up because of inflation and other factors, but not because of your age.
Attained-Age-Rated: The premium is based on your current age, increasing your premium as you get older. Premiums are lower when you are younger, but continually increase as you age. Premiums may also increase because of inflation or other factors.²

When to Enroll in Medicare Supplement Plans

When You’re First Eligible: The best time to enroll in a Medicare Supplement plan is when you’re first eligible, which is on the first day of the month in which you turn 65. This enrollment period is known as your Medigap Open Enrollment Period, which lasts for six months, and you must already be enrolled in Medicare Parts A and B.

During this period, you can buy any Medigap policy sold in your state, regardless of any health issues.

Outside Open Enrollment: While it’s often better to get coverage when you’re first eligible, you can still apply for Medigap coverage after your Initial Enrollment Period. However, if you apply for coverage after your Initial Enrollment Period, there’s no guarantee that an insurance company will sell you a policy if you don’t meet the medical underwriting requirements.

FAQs About Medicare Supplement Plan M

Learn more about Medicare Supplement Plan M with answers to frequently asked questions.

Do Medicare Supplement plans cover pre-existing conditions?

While insurance companies can’t make you wait for your coverage to start, they may make you wait for coverage for a pre-existing condition. Coverage for pre-existing conditions can be excluded if the condition was treated or diagnosed within six months before the coverage starts under the Medicare Supplement plan.
After the six-month period, the Medicare Supplement plan will cover the condition that was previously excluded. However, it is possible to avoid or shorten the waiting period for a pre-existing condition if you buy a Medicare Supplement plan during your Medigap open enrollment period to replace the “creditable coverage” Medigap plan.³

How can I lower the costs of my Medigap Plan M?

While Medicare Supplement Insurance plans, meaning they offer the same benefits, the prices can be different between insurance companies. Shopping around is the best way to make sure you have the plan that you need at a price you can afford.

Do Medigap plans vary by state?

Medigap plans are standardized, meaning they offer the same benefits across most of the states, except for Wisconsin Medicare Supplement Plans, Minnesota Medicare Supplement Plans, and Massachusetts Supplement Plans.

Compare Medicare Supplement Plans

With the number of Medicare Supplement plans available, it’s hard to know which one may be right for your needs. Explore the different Medicare Supplement plans below.

Sources:

https://www.medicare.gov/basics/costs/medicare-costs
https://www.medicare.gov/health-drug-plans/medigap/basics/costs
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

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