When looking at the Medicare Supplement plan options available, it can be extremely overwhelming. Initially when you review Medicare’s chart of the MediGap plans available, you’re faced with 11 different options! How are you supposed to know which option is going to be the best fit for you? Luckily, we can narrow that chart down to just a few options that will provide you with fantastic coverage, and one of those options is Medicare Supplement Plan N.
What is Medicare Supplement Plan N?
Medicare Supplement Plan N, also known as MediGap Plan N, is a plan designed to help fill in the gaps left by your Medicare Part A and Medicare Part B (Original Medicare). Original Medicare leaves Medicare enrollees with many out-of-pocket costs, including deductibles and coinsurances. Plan N is designed to limit many, but not all of these out-of-pocket costs.
MediGap Plans: A Simple Review
When you turn 65, you can voluntarily enroll in Medicare. This is a federally-facilitated health insurance program that you have paid into for most of your working life. Original Medicare, also known as Medicare Part A and Medicare Part B, will only cover a portion of your healthcare, but you will be responsible for some of your remaining medical expenses. Your cost-share under Original Medicare includes, but isn’t limited to, deductibles, coinsurances/copayments, and excess charges. These cost-shares can be considered your “gaps in coverage.”
In our retirement years the last thing we want to do is worry about unexpected medical costs piling up. Luckily, there are plans available that can help to fill in these gaps and give Medicare enrollees peace of mind. Plans that are designed specifically to work with Original Medicare are called Medicare Supplement Plans, or MediGap Plans.
Medicare Supplement Plans
Fortunately for you, the government has standardized these Medigap plans. This will mean that the only difference between each lettered plan is going to be how much you monthly for the premium based on the insurance company you enroll with. Essentially the benefits offered under a Plan N, regardless of insurance carrier, must be identical. CMS mandates each plan’s benefits, and a Plan N cannot offer more benefits or less benefits than another Plan N, just because the insurance carrier is different.
If you are currently covered under Medicare Part A and Medicare Part B, you’re eligible to purchase a Medicare Supplement plan. It is extremely beneficial to apply for a MediGap Plan to begin at the same time as your Medicare Part B, so you are not subjected to limitless out-of-pocket costs. We want all of our insurance coverage to be streamlined.
When it comes to your options for choosing a Medigap plan, there are going to be twelve to consider. They will be labeled as follows: A, B, C, D, F, high-deductible F, G, high-deductible G, K, L, M, and N. In case you were wondering what happened to plans E, H, I, and J, these plans won’t be available to purchase as a supplement to your Medicare. Also, if you turned 65 after January 1st, 2020, you are not eligible to enroll in Plan F, Plan C, or Plan F high-deductible.
What do I Need to Know About Medicare Supplement Plan N?
As we mentioned previously, Medicare Supplement plans are designed to fill the gaps left behind by Original Medicare- Medicare Part A and Medicare Part B. Medicare Supplement Plan N helps to cover many of these aspects, with minimal out-of-pocket for your cost-share.
What Does Medigap Plan N Cover?
|Benefits Covered||Plan N|
|Part A Hospital Coinsurance and 365 Extra Hospital Days||100%|
|Part A Deductible||100%|
|Part B Coinsurance/ Copayments||100% except certain copayments|
|Part B Annual Deductible||Not Covered|
|Part B Excess Charges||Not Covered|
|First 3 Pints of Blood||100%|
|Cost of Foreign Travel Emergency||80%|
|Hospice Care Coinsurance||100%|
|Part B Preventative Care Coinsurance||100%|
|Skilled Nursing Facility Care Coinsurance||100%|
Medicare Supplement Plan N covers many benefits 100%
- Plan N covers the Medicare Part A hospital coinsurance during your hospitalization. If you are hospitalized more than 60 days per benefit period, under Original Medicare you begin to incur coinsurance for each continued day of hospitalization- $371 days per hospitalization. Once you have been hospitalized for 90+ days, your coinsurance increases to $742 per day, and you begin to utilize your Medicare lifetime reserve days. Medicare Supplement Plan N covers these coinsurance amounts at 100%, and also provides an additional 365 lifetime reserve days if you have exhausted your Medicare lifetime reserve days for hospitalization.
- Plan N covers the Medicare Part A deductible of $1484 at 100%. It is important to remember that the Part A deductible is per benefit period, not an annual deductible. This means that if you go more than 60 days between hospitalizations, the deductible resets. MediGap Plan N will cover this deductible each time you are hospitalized.
- Plan N also covers your coinsurance for hospice care, skilled nursing facility care, preventive care, and the first 3 pints of blood during a blood transfusion.
- Plan N will pay for 80% of foreign travel emergency, up to plan limits.
Your Cost-Share for Medicare Supplement Plan N
Although Plan N covers many benefits at 100%, there are still some benefits that you as the enrollee may be responsible for a portion of-
- Part B Deductible: The Part B annual deductible in 2021 is $203. Enrollees in Original Medicare with MediGap Plan N must meet this $203 annual deductible prior to Medicare or Plan N covering any services.
- Certain Copayments: Plan N does have the possibility of copayments for some visits. Luckily, the amount a provider can charge for a copayment is capped. An office visit, regardless of physician type or specialty can have a maximum copayment of $20. If you visit the Emergency Room, but you are not admitted as an inpatient, you can have a maximum copayment of $50. These copayments are not always as high as $20 or $50, but they can never exceed that amount.
- Excess Charges: Plan N has the possibility of an excess charge. An excess charge may be present if the provider you are utilizing does not accept something called Medicare Assignment. If you provider does not accept Medicare Assignment, you may be responsible for up to 15% of the Medicare-approved amount of the bill. Excess charges will be explained more in depth below.
Although Plan N does have a small amount of cost-share, it is still a full-coverage plan that will significantly limit your out-of-pocket spending on your Medicare costs.
What Are Medicare Excess Charges?
To be honest, an excess charge sounds a little scary, doesn’t it? It is somewhat of a looming term when you hear about MediGap Plan N. Luckily, it really isn’t as scary- or common- as it sounds!
When physicians and other healthcare providers agree to accept Medicare as a form of insurance, they are given the option to be either a participating provider or a non-participating provider. A participating provider is a provider who accepts the payment from Medicare as payment in full and does not bill the Medicare beneficiary for any additional cost of the visit or procedure. Although a significant number of providers accept Medicare Assignment, there is still a small faction of doctors and healthcare providers who do not, and are considered non-participating providers.
If your doctor is a non-participating provider and does not accept Medicare Assignment, it means that he/she does not accept Medicare’s payment as payment in full. This means that on-top of what Medicare is paying your doctor for a visit or service, you may be charged by your doctor’s office for up to 15% of the Medicare-approved cost. This 15% that you are being billed is referred to as an excess charge.
Although the majority of doctors and healthcare providers across the country accept Medicare Assignment, there is still the possibility of encountering an excess charge with Medicare Supplement Plan N. Luckily, Medicare.gov has a very easy to use provider tool where you can look up doctors by name or specialty in your zip code and determine whether they accept Medicare Assignment, or not. If your doctor appears with a little green checkmark by their name, you don’t have to worry about an excess charge!
There are even a few states the prohibit providers from billing an excess charge! If you live in one of these 8 states, you don’t ever have to worry about seeing an excess charge, unless you visit a provider across another state’s lines-
- New York
- Rhode Island
*In CT you must be a member of CONNMAP/QMB
Does MediGap Plan N have a Network of Doctors?
With any of the Medicare Supplement Plans, there is no network of doctors or physicians that you have to adhere too. If a provider accepts Medicare as an insurance, they automatically accept your Medicare Supplement plan, as Original Medicare takes control of the billing.
Essentially, you can use your Medicare Supplement Plan N in all 50 states, as long as the doctor accepts Medicare! This is one the greatest benefits of Original Medicare with a supplement, as you have access to the best doctors and healthcare providers across the country without worrying about paying out-of-network charges. You are in control of your healthcare!
Also, like other Medigap insurance plans, Plan N does have some benefits for traveling outside the US. It will include any ER care you receive within your first sixty days in another country. Your plan will cover 80% of your treatment up to plan limits- usually $50,000. Even so, it’s best to contact your insurance agent to discuss what your plan covers before traveling outside the US. It is better to be safe than sorry.
How Much is the Premium for Medicare Supplement Plan N?
Keep in mind that when it comes to your Medigap Plan N or any other Medicare Supplement Plan, these are going to differ by your location and by your insurance company. Many private insurance companies will use a price ranking system to set the premiums they will charge you for.
- Community-rated: When it comes to this type of a rating system, everyone will pay the same no matter what their age. However, when it comes to inflation, this will directly affect the pricing, but it will not increase as you get older.
- Issue-age-rated: This part of the premium will be based on how old you were when you made the plan’s purchase. It means to you that the younger you are, the less it’s going to cost you when you purchase your plan. However, the price will not go up as you get older.
- Attained-age-rated: With this type of rating system, your premium will start low and increase as you get older.
Each insurance provider has their own premium set for Medicare Supplement Plan N. Keep in mind that when you are going to shop for a plan, it is essential to know what their price rating system is and how that may impact your rate increases throughout your enrollment in the plan. This will also help you understand the initial cost of the premium when you first begin your enrollment.
Another thing to consider when you’re researching a supplement policy for your Medicare insurance, make sure you’re comparing oranges to oranges and not apples to oranges. This means that if you were looking for a specific Plan N, you want to look at other Plan Ns across the board. You don’t want to look at two different types of plans to compare. A Plan C compared with a Plan B will show no exact comparison with differing plans like these two, especially when it comes to the benefits.
Enrolling in Medigap Plan N
So, you’ve decided you like the coverage level of Plan N and the premium fits right into your budget. Now you’re left wondering, “how do I get a Plan N” and “when do I enroll in Plan N?”
When it comes to enrolling in a Medicare Supplement Plan, you want to line up your enrollment to begin the same month that your Medicare Part B begins. This way, your coverage is streamlined, and you aren’t left with any gaps in your coverage which can lead to unexpected medical bills. When your Part B begins, you have 6 months to enroll in a Medicare Supplement plan without having to answer any health questions. These 6 months are absolutely crucial if you have any underlying health conditions that may pose a problem for medical underwriting. If you apply after your 6-month window, you will have to answer a list of health questions, provide a list of your prescriptions, and likely complete a telephone interview, giving the insurance company the ability to either approve or deny your coverage at their discretion.
Things to Know Before You Purchase a Plan
If you want to enroll in this plan or another Medigap plan, you should consider at least five things before you go forward and make a purchase.
- Before you can enroll in Plan N, you must have your enrollment in Medicare Part A and B completed.
- You can have either a Medicare Supplement plan or a Medicare C (Medicare Advantage) Plan, but you cannot have both. Even though you can still apply for one, you must be ready to leave the Medicare C Plan before your Medigap plan starts.
- Medigap policies will only cover one person. Therefore, if you have a spouse, you will need to purchase a different policy for them. Luckily, many companies provide spouses with discounts on premiums, known as household discounts.
- Medicare Supplement Plans are going to be renewable. Once you are approved for a MediGap policy, you will remain enrolled in that plan, unless you initiate a disenrollment yourself, regardless of your health status.
- Another thing to consider is that Plan N won’t cover all your expenses. When it comes to a Medigap Plan, these plans cover everything that Medicare covers. Since Original Medicare does not cover things like dental, vision, hearing, prescription drugs, etc, neither will your Medicare Supplement Plan N. There are separate stand-alone plans to cover these other areas should you need coverage.
Is MediGap Plan N the Right Coverage for You?
When it comes to deciding whether Medicare Supplement Plan N is the right fit for you, there are a few factors to consider. One large important factor is cost. Medicare Supplement Plan typically has an affordable premium, but you want to compare the premium to the next highest coverage level (Plan G) to see which plan would be most cost-efficient in the long-run. If you have a high medical need and have multiple appointments throughout the month, you need to consider not only premium cost, but copayments and excess charges that will also factor into your plan cost.
With any Medicare plans, there are going to be benefits and drawbacks. Navigating through them can be a little challenging at times, but it helps to keep track of what you need for your current healthcare and have a bit of a plan for what you may need in the future. Speaking to an agent can prove very helpful in figuring out if this plan will be the correct one for you. In the end, you want to make sure that all of your healthcare will be covered as much as possible. Unfortunately, emergencies do happen, and you don’t want to be left with a huge medical bill or having to drain your retirement savings to pay for any medical expenses.