While many of Medicare’s supplemental plans pay heavily toward one type of services or another, Part M is geared to be a “middle of the road” set of benefits. Rather than offering robust prescription drug coverage or setting a low cap on annual out of pocket costs, this plan takes a very specific approach to the extra expenses one might incur after Part A and Part B pay their portions.
A Quick Review
Part M is very detailed when it comes to the coverage it provides, so it’s important to know just how Medicare Part A and Part B will factor into this selection. Original Medicare pays some hospital and medical expenses and generally contributes toward hospital stays, physical therapy, durable medical equipment, lab work, and more. Visiting a Medicare provider is key to ensuring that Original Medicare will pay a portion of your expenses.
Once Parts A and/or B have contributed their allowable amounts, Part M will assist with a range of charges including but not limited to some Part A coinsurance and copayments, Part B coinsurance and copayments, skilled nursing facility care coinsurance, and more. As with most supplemental plans, Part M will not pay toward your Part B monthly premiums.
Part B deductibles are also not included in Part M coverage, as is the case for nearly all other Medicare supplements. Part B excess charges, the difference between what your physician bills for a service and the Medicare-approved reimbursement amount, are also not covered under Part M.
Understanding Your Premiums
One of the more unique aspects of Part M coverage entails what monthly premium you will be charged. For many Medicare supplement plans, your rate is calculated based upon your income and tax status, but this plan works a bit differently. As all supplement plans are issued by private insurance carriers and not the federally funded Medicare program, a variety of factors go into your monthly premium. Age, gender, and health status can all affect how much you pay for Part M coverage.
It’s recommended that you enroll in Medicare Part M during your Open Enrollment Period, which begins on the first day of the month that you turn 65 and are enrolled in Part B and extends for six months after. During this OEP, you will be guaranteed coverage through Part M no matter your current health condition. If you choose to enroll in Part M outside of this time period, you could be subject to medical underwriting, which can largely affect your monthly premiums.
When considering Medicare Part M, it’s smart to estimate your annual medical expenses to the best of your ability. If you are generally in good health and will not use your coverage much, the extra monthly cost of this plan may not make sense. However, others do like to have this supplement in the event of an emergency as it will certainly help to lower your overall out of pocket costs.