Like all insurance plans, it is important to understand the gaps in any policy you might choose. The gaps in Plan N are reasonable for most and usually do not expose the insured to significant yearly expenses.
There are three gaps with Plan N (when compared to Plan F that fills all gaps) and we will explain the out-of-pocket costs associated with each gap below.
Plan N is unique in that it is the only Medicare supplement that has a doctor’s office copay associated with it. This simply means that doctors can charge you a fixed copay for an office visit. In this way, Plan N is very much like most traditional health plans for those under age 65.
The maximum 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 the summer of 2010. The bureaucrats at Medicare (CMS) could always choose to change these numbers in the future. If they do, it will affect all N plans – both new and old.
It’s interesting to note that the doctor’s office copay can be less than $20 depending on certain formulas and coding practices by various healthcare providers. If you visit several doctors on a regular basis, then Plan N may not offer significant savings over a Plan G or Plan F.
Like Plans G and D, Medicare supplement Plan N does not cover the Part B deductible. Of the two Medicare deductibles this is the smaller one – Part A is the larger one. Part B applies to doctors visits and out-patient procedures whereas Part A occurrences are for hospital and in-patient procedures.
For 2014, the Part B deductible is only $147 – just like it was in 2013. In 2012, the yearly deductible was $140 and for years 2011 and 2010 it was $162 and $155 respectively. As you can see, it is not a very large number as far as insurance deductibles go.
The risk with Plan N (albeit a slight one) is that Medicare officials would increase the Part B deductible significantly in the future. As this change would affect all Medicare supplement plans both past and present, it would likely be a wash across the board.
In our opinion, it is unlikely the Part B deductible will change drastically for those already enrolled in Medicare. The Part B percentage increase year over year (if there is one) has always been modest and will likely remain that way. The Plan N Medicare supplement appears to be a safe bet when accounting for the Part B deductible.
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 not widely encountered. In some states, like Ohio for instance, Part B excess charges are unallowable. If you are considering Plan N in a state like Ohio, then you need not worry about excess charges at this time.
Should you ask, your doctor will tell you if s/he does not accept Part B Medicare approved amounts. You would then have a choice of finding a doctor that does accept Medicare assignment or paying this cost out of pocket. In most cases, Part B Excess Charges are reasonable when encountered.
Hyers and Associates is an independent insurance agent specializing in Medicare supplements, Advantage plans, and prescription Part D coverage. We license direct with all of our carriers and can help you compare Medigap quotes from many, many insurance companies.
If you are considering Plan N Medicare Supplement insurance or any other Medigap plan, contact us today and 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 Supplements