Medicare Supplement Plan N has become one of the more popular choices. It has some unique features which make it more appealing than some of the other available Medicare supplement plans. This article explores how Medicare Plan N works.
Medicare Plan N Coverage
Medicare Plan N fills seven of the nine coverage gaps left by the Original Medicare insurance. (Learn more about Medicare Supplement Plan F HERE and Medicare Supplement Plan G HERE). The only gaps not covered are Medicare Part B’s $147 deductible and any excess charges that fall under Medicare Part B which are above the Medicare-approved amount. That means that any time you are admitted to the hospital you, and the 20% coinsurance for Medicare Part B will be completely covered.
What sets Medicare Supplement Plan N apart is that it requires copays for some services. A standard doctor’s visit has a $20 copay and an emergency room visit that doesn’t result in admission calls for a $50 one. The Plan’s provisions were designed to prevent individuals from abusing the Medicare Part B system.
Additional Medigap Plan N coverage includes:
- Medicare Part A Deductible
- Medicare Part A Coinsurance
- Medicare Part B Coinsurance
- Hospice Care Coinsurance or Copayment
- Skilled Nursing Facility Care Coinsurance
- First Three Pints of Blood
Out-of-pocket expenses include:
- Medicare Part B’s $147 Deductible
- Medicare Part B Excess Charges
- $20 copayment for doctor visits and $50 for an emergency room visit that doesn’t result in admission.
Eligibility and Enrollment
Eligibility for any Medicare Supplement Plan requires enrollment in Medicare Parts A and B. Since these plans are distributed by state, you must reside in one that offers Plan N (only three states do not). While you can enroll in Plan N any time if you meet the eligibility requirements, the ideal time would be when you enroll in Medicare Part B. You have a six month window—known as open enrollment—when you sign up for Medicare Part B. During that time, insurance companies only consider your age when enrolling in a plan. There is no medical underwriting. If you don’t enroll during this period and suffer from an illness or disability, your rates could be significantly higher. You may also be excluded because of underwriting.
Why Choose Plan N?
The reason comes down to premiums versus risk. As a rule, Medicare Plan N costs 25% less than Plan F. If your Medicare Part N monthly premiums are $30-$40 lower, you may want to enroll in Plan N. If they are only $10 less, you should consider Medicare Supplement Plan F or G.
Let’s use a real-life example to help put this in perspective. Patient X goes in for an outpatient procedure at their local doctor’s office. Medicare approves the procedure for $1,000. The doctor, however, charges $1,100. In this situation, Patient X would have to pay:
- Medicare Part B’s $147 deductible
- $100 in excess charges over the Medicare-approved amount
If the patient paid $21 less per month in premiums, they’d break even with Plan F; $8.50 less in premiums and they’d break even with Plan G. These numbers would be better if no procedure was required.