The Medicare Supplement Plan N first came on the market in 2010 and has been demonstrated to be a top-rated plan for many people. Plan N is similar to other supplement plans because of the requirements placed on all insurance carriers who offer supplemental medicare plans. All insurance carriers are required to have the same essential policy benefits. However, there is some flexibility for each insurance carrier which makes each program have slight differences even though they have the same basic coverage—consulting 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 navigate the differences between each project and each insurance carrier. This way, you can be assured of finding the plan that best fits your financial budget and needs.
A benefit of Plan N is that it is available from many reputable and well-known insurance companies. (The quality of the insurance company you choose is essential in selecting a plan). Plan N is very similar to supplemental Plan F, with only a few differences that may make a big difference in your situation.
PLAN N COVERAGE
The brief chart below lists some basic coverage and indicates which Plan N includes. These are all items to consider when comparing plans and to determine which method best fits your current and projected health needs and budget.
Medigap Plan N
As you can see from the chart, Plan N covers everything except the Part B Deductible and the Part B Excess Charge. Let’s look in more detail at this plan. It is a standardized Medicare Supplement Plan that covers what Medicare Part B does not cover.
[ For clarity’s sake, Medicare Part B covers outpatient doctor visits and treatments.]
Plan N covers visits to your doctor for routine preventative care or illness. It also covers outpatient doctor visits if you are hurt or need to be transported in an ambulance. Plan N covers any blood work or imaging you may need and many other medical services.
If Medicare Part A or B covers the needed medical issue, Medicare Supplement Plan N will protect it. For these outpatient visits, Medicare covers 80% of charges; the remaining 20% gets billed to the patient – you. This is where Plan N is of benefit: if it pays for that remaining 20% not covered by Medicare.
This is something Plan N does not cover. Plan N requires a $20 copay for each outpatient doctor’s visit. The copay amount you will be required to pay for Emergency Room visits is $50. When choosing a plan, consider how many visits you make to a doctor each year. And how many you anticipate making in the coming year. The copays can add up if you need multiple doctor visits in a year. Please note: Plan N does not charge you copays for inpatient hospital stays or treatment.
Plan N does cover your Part A deductible. [Again, for clarity, Medicare Part A covers hospital inpatient treatment.] Plan N will not cover your deductible for Medicare Part B, the outpatient doctor’s office visits. Instead, you would be responsible for paying the Part B deductible. However, unlike the higher Part A deductible, the Part B deductible for 2023 is only $226.00
The term “excess charges” means the number of your doctor’s charges above and beyond the standard allowance for Medicare Part B. Plan N does not pay the excess amount. Instead, you would be responsible for paying charges over and above what Medicare allows.
WHAT ABOUT PREVENTATIVE CARE
Here’s the good news: Medicare covers preventative carefully! Many people don’t take advantage of this benefit. Yearly physical exams, bloodwork, and mammograms — are all covered in full by Medicare. What typically happens is that Medicare pays 80%, and then Plan N covers the remainder, leaving no charges for you to pay. There is an exception (of course!) if you see a doctor who does not accept Medicare assignments.
What if my doctor is not a Medicare provider?
This means the doctor has not contracted with Medicare to provide treatment for the fees Medicare has set. If your doctor does not accept Medicare assignment, and you have Plan N, this is how it works: The doctor accepts as “partial payment,” the amount Medicare will reimburse. You, then, are responsible for (1) your copay, which is $20 with Plan N, and (2) up to 15% of the remaining charge. You might have to pay the entire charge upfront and then get reimbursed for the portion Medicare will pay.
PLAN N COVERS HOSPITAL SERVICES.
The hospital services covered by Plan N include the following: inpatient room charges, inpatient doctor visits, inpatient treatments including surgery, and blood transfusions (including 3 pints of blood). Also included in Plan N coverage are home health care, hospice care, skilled nursing, and other inpatient services. Plan N does cover the deductible for your hospital stay. (This is the Medicare Part A deductible for 2019 is $1,600 — a nice benefit!) Another Plan N use is that when you are hospitalized, Plan N will pay your coinsurance (20%) and up to one (1) year of additional hospital benefits once your Medicare coverage has been used.
WHAT ARE THE COSTS OF PLAN N?
With Plan N, you will need to pay doctor visit copays of up to ($20). And you will be expected to cover any Part B excess charges you incur. It would be best to cover the full Medicare Part B deductible ($226 for 2023).
Here’s the real benefit of Plan N compared to, say, Plan G. Plan N monthly premiums are typically significantly lower than Plan G. So every month, you are getting a “discount” on your premiums compared to Plan G. If you are blessed with good health and rarely need to visit a doctor (other than for preventative care), Plan N could be an excellent choice for you.
If you choose Plan N, you will have a lower monthly premium than most other supplements. The costs you would be responsible for are as follows:
- The annual Part B deductible (2023 -$226),
- Copays of up to $20 for outpatient doctor’s appointments and a $50 copay for emergency room visits.
- Excess charges to some providers.
When comparing supplement plans, consider the number of doctor’s office appointments you tend to need each year versus only seeing your doctor for preventative care. Plan N may be your best choice if this latter is your situation. Also, consider if your medical providers all accept Medicare assignments. If they do, with Plan N, you could be enjoying the benefit of reduced monthly premiums with minimal extra risk for additional payments.
ENROLLMENT: THE 6-MONTH WINDOW
The best time to enroll for a supplement plan to your Medicare is during your open enrollment period. This enrollment period is different for everyone and is based on your birthday (among other factors, such as when your employee medical coverage benefits end). Specifically, your enrollment period is the 6-month window that starts six (6) months before the date when Medicare Part B would first be in effect for you. You may be on Medicare Part A when you turn 65. Still, if you are not retired and continue on a company medical insurance plan, Part B enrollment is delayed until your employee medical benefits end.
Here’s an example: if you are at least 65, your birthday is in June, and you are/will be no longer covered by employee benefits, your enrollment period starts January 1 — 6 months before June. You may enroll any time within that 6-month window, although the supplement plan will not take effect until your birthday month (in this case, June). This enrollment window is the only time you can be guaranteed to enroll in a supplement plan without health underwriting. Unless the state you live in has special provisions.
HOW CAN WE HELP
The regulations around enrollment are highly individualized and depend on multiple factors of a person’s situation. The state of residence and the different requirements of individual insurance carriers, to name a few. Articles are a great place to get basic information. However, enrollment has become so complex that it requires a licensed, highly knowledgeable, and experienced Medicare agent to guide you through all the requirements that apply to you in your circumstances. Avenue Insurance Planners is licensed and has extensive experience with various requirements. Your health, finances, and needs are unique, and your plan should fit all those unique aspects. Schedule a consultation today to allow us to look at your options with you.
- We are experts at guiding you to the options that best match your health needs, financial needs, and personal perspective.
- Take a look at your current and anticipated circumstances.
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