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What is Medicare Supplement Plan N?

Medicare Supplement Plan N is our 2nd favorite Medigap plan (favorite is Plan G) that we recommend to our clients.  Plan N offers extensive coverage at rates typically 25-30% lower than Plan F.  This annual premium difference in our opinion more than makes up for the difference in benefits as it still provides you with comprehensive coverage at a bargain price.

Medigap Plan N

What is Covered Under Plan N?

If we are comparing Plan N to Plan F the easiest way is to look at what Plan N doesnt cover that Plan F does cover.  There are 3 Medicare "gaps" that Plan N does not cover 100%:

  1. ​Medicare Part B coinsurance or copayment:   Original Medicare pays 80% of your Part B claims.  If you are on Plan N it pays your 20% portion but you are responsible for up to a $20 copayment for some office visits and up to $50 copayment for emergency room visits that do not end up with admission as an inpatient.
  2. Medicare Part B Deductible:   In 2016 your Medicare Part B deductible is $166 annually.  Plan N does not cover this therefore you are responsible the initial $166 of Part B claims.
  3. Medicare Part B excess charges:  Part B excess charges only apply to providers who DO NOT accept Medicare assignment.  By accepting Medicare assignment the doctor agrees to accept Medicare payment as full payment and have agreed to Medicare's reimbursement rates.  If a provider does NOT accept Medicare assignment then they can charge up to 15% above the Medicare approved amount.  Be sure to check with your provider to ensure that they accept assignment...chances are that they do as close to 96% of all doctors and hospitals accept Medicare assignment.

See the chart below and you will see how Plan N compares to both Plan G and Plan F.

Medicare Benefits

A

B

C

D

F

G

K*

L*

M

N

Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Medicare Part B coinsurance
or copayment

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%
**

First 3 Pints of blood

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Part A hospice care
coinsurance or copayment

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Skilled nursing facility care
coinsurance

100%

100%

100%

100%

50%

75%

100%

100%

Part A deductible

100%

100%

100%

100%

100%

50%

75%

50%

100%

Part B deductible

100%

100%

Part B excess charges

100%

100%

Foreign travel emergency

80%

80%

80%

80%

80%

80%

* For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), the Medigap plan pays 100% of covered services for the rest of the calendar year

** Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission.

Why Should You Choose Medicare Supplement Plan N?

Medicare Supplement Plan N are for people that want the most economical plan and don't mind having additional claims that come with the annual premium savings.

If you are comfortable with paying up to $20 (after your $166 Part B deductible is met) each time you go to the doctor and are confident that all your doctors accept Medicare assignment then Plan N may be right for you.

Also if you live in Pennsylvania, Connecticut, Massachusetts, Minnesota, New York, Ohio, Rhode Island or Vermont your state does not allow doctors to charge Part B excess charges.  Therefore if you were to purchase Plan F or Plan G you would be paying for a benefit that you do not need.  These states are referred to as a MOM State as the law that was passed for this is called the Medicare Overcharge Measure (MOM).

Why Should You NOT Choose Medicare Supplement Plan N?

Most seniors we talk with like to know what they are going to have in medical expenses if something big happens to them.  This way they can budget easier.  With Plans G and F you know you are going to be exposed to $166 or $0 annually, respectively.  Therefore it makes budgeting easy.

With Plan N you don't really know your exact out of pocket exposure.  Let's say for example that you had to have a knee replacement and had to do 6 weeks of physical therapy three times each week.  This would add an unexpected $60 in copays for each of those 6 weeks...or an additional $360 to your total costs.

If you happen to have a significant amount of copays or happen to get hit with excess charges then you will likely eliminate any premium savings that you had by choosing Plan N over Plan G.  Some people are willing to take this chance and are very happy with their choice.