If you’re shopping for Medicare supplement insurance, you might be considering Plan N as an option. With all Medigap coverage, you’re weighing benefits vs. premiums.
It’s important to know that the gaps uncovered by Plan N are small. Rarely do they expose you to significant expenses.
There are three gaps Plan N does not cover. We will explain the out-of-pocket costs and exposure associated with each one below.
First, let’s list the three gaps in Original Medicare that Plan N does not cover. They are:
Those are the only gaps not covered by Plan N. It’s important to know that your out-of-pocket exposure is low and predictable with these three benefits.
Plan N is unique in that it’s the only Medicare supplement with doctor’s office and emergency room copays. This means you may be responsible for a small copy when you visit your primary care doctor or any specialist. In this way, Plan N is like traditional health plans you see before age 65 that require copays at the doctor’s office.
The Plan N copay is $20 for a doctor’s office visit – and $50 for the emergency room. These fixed amounts have not increased or decreased since the inception of Plan N in 2010. Medicare (CMS) could choose to change these amounts in the future, but it’s unlikely they will. If they do, it will affect all N plans – both new and old.
It’s interesting to note that your doctor’s office copay could be less than $20, but never more. It depends on the billing practices of your doctor’s office. Specialist visits are also $20 – they are not allowed to charge more. You should also know there is no special copay for Urgent Care. It would be $20 as well.
Like Plans G and D, Medicare supplement Plan N does not cover the Part B deductible. Of the two Medicare deductibles, it is the much smaller one. Part A is the big one. Part B applies to doctor visits and outpatient procedures. Part A occurrences are for hospital and inpatient procedures.
For 2023, the Part B deductible is $226 which is a $7 decrease from 2022. It was $233 in 2022, $203 in 2021, $198 in 2020, $185 in 2019, $183 in 2017-18, and $166 in 2016. As you can see, it usually does not move much. This is because it’s tied to inflation. The increases are not arbitrarily set; rather they are tied to inflation metrics which usually move slowly.
If the Part B deductible increases significantly, you should know that Medicare supplements covering this gap will increase their premiums in kind. They will not absorb this cost. It will be passed on to you. One way or the other you are paying for it. At least with Plan N, you have some control over it.
And you may know that no new supplements can be sold after 2020 covering the Part B deductible. This will force consumers to have more skin in the game when it comes to their Medicare coverage. These changes will make Plan N even more attractive. It may end up being the Medigap policy with some of the smallest rate increases.
You would only face Part B Excess Charges if you choose to see a doctor who does not accept Medicare Assignment. This could be a doctor who charges more than what is allowed by Medicare. The maximum Part B Excess amount is 15% above what Medicare deems to be normal and customary.
Plan N does not cover Part B excess charges, but these fees are very rarely encountered. In many states, like Ohio for instance, Part B excess charges are not allowed. If you are considering Plan N in a state like Ohio, then you need not worry about Part B Excess Charges. Doctors cannot charge them even if they want to.
The states where Part B Excess Charges are not allowed, include: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. (You can compare the list of what each supplement covers here.)
But most doctors simply won’t charge Part B Excess – even if they are in a state where they’re allowable. It would be hard for them to stay in business. Consumers would simply find another doctor. We have several Plan N clients here at our independent insurance agency. No one has told us they are running into this gap and it’s causing them problems.
The argument for Plan N is a simple one: You can lower your monthly premiums without adding significant out-of-pocket exposure.
The premiums you save in most cases will more than makeup for the gaps not covered by this particular supplement.
The copays are small and have not increased since Plan N was released in June 2010. It’s unlikely they ever will.
The Part B deductible is the smaller of the two Medicare deductibles (Part A deductible is much higher and covered by Plan N) and will not break the bank.
Part B Excess charges are very rare and in the event you encounter them, you can always change doctors so that you do not run into that problem again. And if you live in Ohio, it’s a moot point – doctors are not allowed to charge Part B Excess amounts.
This may be more of a “peace of mind” argument. Many of our clients simply want the best coverage money can buy. So they buy Plan F or Plan G. There is nothing wrong with that idea – it goes a long way in retirement. We always recommend drilling down a little further, however. Peace of mind today can lead to frustration tomorrow.
But in other cases, you may be visiting several doctors on a fairly regular basis. You may worry about the copays adding up over time. Or perhaps you have a favored doctor who doesn’t accept Medicare Assignment and you’re running into frequent Part B Excess charges.
These are valid arguments against a Part N plan. It has more gaps needing to be covered by you the insured than some other supplements. In this case, perhaps one of the other more comprehensive plans would be of better value.
Hyers and Associates is an independent insurance agent specializing in Medicare supplements, Advantage plans, and Prescription Part D drug coverage. We license direct with all of our carriers and can help you compare Medigap quotes from several insurance companies.
If you are considering Plan N Medicare Supplement insurance or any other Medigap plan, contact us today. We can help you compare rates, benefits, and out-of-pocket exposure so you can enroll in the plan that best fits your needs and budget.
Category: Medicare SupplementsLast updated on February 16th, 2023