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Medigap Plan N

The Medicare Supplement Plan “Medigap Plan N” was introduced in 2010 and has proven to be a very popular plan for many people. Medigap Plan N is similar to other Medigap Plans.  This is because all of the insurance carriers who offer Medigap plans are required to have the same basic policy benefits regardless of the insurance company that offers the plan. However, there is wiggle room for each insurance carrier, which makes each plan have slight differences even though they have the same core coverage.   Seeking help from an independent insurance agent, who is familiar with all the unique differences of each supplemental plan and each insurance carrier, is invaluable in helping you evaluate the differences for each plan and insurance carrier. In this way, you can be assured of finding the plan the fits your needs and finances best.

The Medicare supplemental plan Medigap Plan N is available from many of the well-known and well-respected insurance companies. (The quality of the company that you choose is an important aspect of choosing a plan).  It is a very similar plan to Medigap Plan F with a few differences that may make a world of difference for your situation.

Medigap Plan N Coverage

The following brief chart highlights some of the critical items to consider when comparing plans and deciding which plan best fits your health needs and financial situation.

Medigap Plan N
Medigap Plan N

Medigap Plan N

Let’s look in more detail at Medigap Plan N. It is a standardized Medicare Supplement Plan that covers what Medicare Part B does not cover. [Review: Medicare Part B covers outpatient doctor visits and treatments.]  For example, Medicare Supplement Medigap Plan N covers things like visiting the doctor for routine preventative care visits or for illness. It covers outpatient doctor visits if you are hurt, or you need to be transported in an ambulance, need blood work or imaging, and many more medical services. If Medicare Part A or B covers the needed medical issue, then the Medicare Supplement Medigap Plan N will also cover it. Medicare Part B covers 80% of outpatient charges; the remaining 20% gets billed to and, of most importantly, paid by Medigap Plan N.  

Copays.   Medigap Plan N requires you to pay a $20 copay at each doctor’s office visit (which, again is a Medicare Part B expense). The copay amount you will be required to pay for Emergency Room visits is $50.  If you need to have multiple doctor visits in a year, this is something to consider as the copays can add up. Plan N does not charge you copays for inpatient hospital stays or treatment.

Deductible. Plan N will cover your Part A deductible. [Review:  Medicare Part A covers hospital inpatient treatment.]   It will not, however, cover your deductible for Medicare Part B, your doctor’s office visits.  With Plan N, you are responsible for paying the full Part B deductible. Do consider, however, that this Medicare Part B deductible for 2019 is only $185.

Excess charges.  “Excess charges” are when your doctor charges you more than the standard allowance for Medicare Plan B.  Medigap Plan N does not pay the excess charge. You are responsible to pay for any excess charges over and above what Medicare allows.

WHAT ABOUT PREVENTATIVE CARE

Here’s the good news to remember:  Preventative care is covered in full by Medicare!  This is a benefit to remember and utilize. Yearly physical exams, bloodwork, mammograms — these are all covered in full by Medicare.  Typically, Medicare will pay 80% and then the Medigap Plan N will cover the remaining costs, leaving no charges for you to pay. There is an exception (of course!).  The exception is for preventive care provided by a doctor who does not accept Medicare assignment.

What if my doctor is not a Medicare provider? This means that they have not contracted with Medicare to provide treatment for the fees Medicare has set.  If they do not accept Medicare assignment, and you have Plan N, here’s how it works: The doctor will accept the amount Medicare will reimburse as partial payment.  You would be responsible for your co-pay ($20 with Medigap Plan N) and up to 15% of the remaining charge. This 15% is a threshold known as a limiting charge and is imposed by states.  States are allowed to make that percentage lower, but they cannot charge you more than 15% of the difference between what Medicare pays and what your doctor charges. Please note: you may have to pay the whole fee up front and seek reimbursement for the portion Medicare will pay.  There are special forms for you to use for this.

PLAN N ALSO COVERS HOSPITAL SERVICES.

The hospital benefits covered by Medigap Plan N include inpatient room charges, inpatient doctor visits, inpatient treatments including surgery, blood transfusions, and 3 pints of blood for those transfusions.  Included in Medigap Plan N coverage are home health care, hospice care, skilled nursing, and other inpatient services. Medigap Plan N will cover your Medicare deductible for your hospital stay (Medicare Part A deductible — for 2019, your deductible is $1,364 ). When you are in the hospital Medigap Plan N will also pay your coinsurance (20%), and one (1) year of additional hospital benefits after Medicare coverage is exhausted,

WHAT DOES PLAN N COST YOU?

You might be thinking that Plan N sounds very similar to Plan G – and you would be correct. How do they differ?  One of the primary differences between Medigap Plan N and Medigap Plan G, for example, is that with Medigap Plan N you will need to pay doctors visit copays, you will be responsible for any excess charges you incur, and you will need to pay the full Medicare Part B deductible.  I imagine at this point you are exclaiming: “So why should I get Plan N! It charges me more!” From the above information, yes. However, here’s the real benefit of Medigap Plan N: Typically Medigap Plan N monthly premiums are significantly lower than Plan G. So every month, you are getting a “discount” on your premiums compared to Medigap Plan G.

There are many circumstances where Medigap Plan N is the clear choice for our clients.  One example would be if you are blessed with good health and rarely need doctor’s visits except for routine preventative care.  If that is true for you, with Plan N you would not be paying multiple copays or excess charges, your Medicare Part B deductible (which for 2019 is $185) would not be an issue, and you would be paying a lower premium every month. In this circumstance, Medigap Plan N would be a great choice.

For Review

Let’s review:  If you choose Medigap Plan N, you will have a lower premium to pay each month compared to most other Medigap plans.  The additional costs you are agreeing to pay by choosing a Medigap Plan N are as follows:

  • You are expected to pay the annual Part B deductible (2019 -$185),
  • You pay copays of up to $20 for outpatient doctor’s appointments and up to a $50 copay for emergency room visits.
  • You’re responsible for any excess charges to some providers. Remember that Medical providers can charge up to 15% more than Medicare allows for billing. Plan N will not cover those excess charges like Plan F or G will. You are within your rights to ask any of your providers whether they accept Medicare assignment (meaning they will not charge excess fees) and choose to use a different provider if they do not accept Medicare assignment.

In choosing a Medicare Supplement Plan, consider the number of doctor’s office appointments you tend to need each year versus only seeing your doctor for preventative care.  If this is your situation, Medigap Plan N may be your best choice.

Consider this

Also, consider whether the doctors you receive care from are accepting Medicare assignment.  Medicare Supplement Plan N may be a good choice for you if they accept Medicare assignment. If they do not, and you want to stay with your doctor, Medigap Plan N may not be the best choice as you will need to pay for your doctor’s charges in excess of what Medicare allows.  If you don’t want to pay the excess for a non-Medicare provider, you will need to change doctors. In this situation, Medigap Plan G, while having a more expensive monthly premium, maybe a better fit for you.

With Medigap Plan G, you could stay with a provider who does not accept Medicare assignment since Plan G covers the excess charges. However, if your preferred providers all accept Medicare assignment, in choosing Medigap Plan N you could be enjoying a reduced monthly premium with minimal extra risk for additional payments.

Choose Your Own Doctors

ENROLLMENT

The 6-month window. The best time to enroll in a Medigap Plan N is during your Medigap open enrollment period. Our culture is becoming less of a plan-ahead culture, and with Medigap plans, you definitely need to plan ahead!  So please pay attention to your enrollment period. Your enrollment period is the 6-month window that starts with your initial Medicare Part B effective date. So for example, if you started Medicare benefits in July, your enrollment period is from July through December.  This window of enrollment is the only time you can be guaranteed to enroll in a Medigap plan without health underwriting.

If you missed that window, don’t worry.  We, at Avenue Insurance Planners, can walk you through your other options.  Did you know that different health insurance companies have different eligibility requirements?  We know these different requirements and we might be able to find a great fit for you.

How can we help

Your health, finances, and needs are unique to you-you need to have a plan that fits all of those aspects of your needs. Schedule a consultation today to allow us to look with you at all of your options. We are experts at guiding you to the options that best match your health needs, financial needs, personal perspective, and your current and anticipated circumstances.  Our job is to show you the pros and cons of each option and let you choose what is best for you without any sales pressure. We would love to make your acquaintance and serve you in this potentially confusing decision.