8 No-Fuss Ways to Figuring Out What Medicare Plan M Covers

Greg Wilson

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8 No-Fuss Ways to Figuring Out What Medicare Plan M Covers

    If you're a retiree wondering what Medicare Plan M covers, making sense of the many different plans available can be challenging. Medicare plan M is a popular choice because it's reasonably priced yet offers many more benefits than the original plan.

    This article will explain what Plan M covers and how it differs from other plans. It also details the risks, costs, and benefits of choosing this coverage for yourself or a loved one.

    When Can I enroll in Medicare Plan M?

    The earliest you can start receiving medical benefits from Plan M is age 65 if Social Security no longer covers you. However, if you've already started receiving Social Security benefits, Plan M will not be available to you.

    Another way to enroll in Plan M is if you are disabled and cannot work due to a physical or mental condition known as an employment-related illness (ERI). For example, if you are under 65 and receiving Social Security disability benefits, you can enroll in Plan M once you turn 65.

    What Coverage Does Medicare Plan M Provide?

    Plan M provides a basic level of coverage. At this level, Medicare plan M:

    • Provides inpatient and outpatient coverage (as well as other services).

    • Gives access to prescription drug coverage.

    • Excludes some tests, treatments, procedures, and supplies; for example, Medicare plan M does not cover “home health services” (provided in a home), hospice care, or mental health services.

    How Much Does Medicare Plan M Cost?

    The cost of Plan M is based on your annual income. For 2022, you will pay a Part B premium, the monthly premium with your Social Security check, or pay directly to Medicare. It's 25% of the total expense to enroll in Plan M.

    As mentioned earlier, Plan M also covers limited services and supplies not covered by other plans. In addition, it makes Plan M a popular choice for retirees and disabled persons.

    The good news is your costs will likely be covered by Social Security. The government subsidizes 70% of the price of Medicare plan M, making it an affordable option for those who need it.

    What Are the Liability Risks?

    Plan M doesn't come with many liability risks. The primary risk is that Plan M doesn't cover some medical services and supplies.

    It means you could spend more money on these services and supplies than you would if you had gone with a more comprehensive plan like Original Medicare.

    Why Choose Plan M?

    Plan M offers significant discounts for business owners, people over age 65, and those who are disabled or have ended employment-related illness (ERI). In many cases, you are eligible for a discount of 25% or more if you choose this plan.

    Plan M is not as comprehensive as the original Medicare, but it still covers many essential services and provides access to prescription drug coverage. In addition, this plan is often significantly cheaper than other plans available through Medicare.

    What is Not Covered in Plan M?

    Plan M doesn't include many essential services and supplies in the original option. However, if you don't meet one of the other criteria, you will likely pay more than you would have if you had gone with the original Medicare option instead.

    For example, Plan M does not cover:

    Emergency Care

    You should always access emergency care no matter how old you are or your health condition. For example, original Medicare ensures that you have access to emergency care on an ongoing basis.

    Home Health Services 

    If you need additional care at home, Plan M will not cover it.

    Hospice Care 

    This service provides exceptional treatment and support for people who need special attention near the end of their lives.

    Mental Health Services

    Mental health services can treat behaviors like depression or anxiety, but Plan M does not cover these.

    Outpatient Prescription Drugs 

    Plan M provides access to a limited number of inpatient prescription drugs, which is generally ineffective for conditions like asthma or high blood pressure.

    Vision Care

    You can get eye exams, eyeglasses, contact lenses, and other items related to your vision. However, Plan M does not cover vision services in general.

    Nutritional Supplements 

    These are products taken by chewing or drinking to provide extra nutritional benefits without adding calories to your diet.


    Plan M is an attractive option for people on Social Security who have ended ERI or are over 65. People who fall into these categories will be eligible for a significant discount if they choose this option instead of the original Medicare option. The government subsidizes 70% of the cost of Plan M, which lowers your monthly premiums and overall expenses.

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