Medicare Supplement Plan N Review

Medicare Supplement Plan N Review

Medicare supplement Plan N is one of ten Medicare supplement plans standardized by the federal government. Medicare supplement plans are also referred to as Medigap Plans.

Medicare supplement plans are offered by private insurance companies and provide additional coverage to Medicare beneficiaries by paying the deductibles and copays left as the patients responsibility by Original Medicare Parts A & B. Medicare supplement insurance offers coverage as secondary insurance to those with Original Medicare as their primary health care coverage.

Our Medicare supplement Plan N reviews will help you understand the pros and cons of Medigap Plan N and decide if it is the right choice for you.   

When Did Medicare Plan N Start?

Medigap Plan N was introduced with the 2010 Medicare Modernization Act, which produced major changes for the federal Medicare program and improved Medicare supplement coverage. The plan is offered nationwide and is standardized so the health care benefits are the same from one insurance company to another. All Medicare supplement plans currently offered are standardized by the federal government and guaranteed renewable. As such, benefits cannot change from year to year. The benefits are guaranteed to renew annually as long as you pay your premiums.  Our Medicare supplement Plan N reviews are meant to help you decide if this is the right plan for you.  

What is Medicare Supplement Plan N

Medicare supplement Plan N is one of six Medigap plans that offer full comprehensive coverage. Full coverage consists of those supplement plans that pay 100% of the deductible and copay for Part A inpatient hospital costs and Part B outpatient services.

How Popular is Plan N?

After the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 phased out Medigap Plan F and Plan C for those new to Medicare as of 2020, the Medicare supplement Plan N has increased in popularity. According to Mark Farrah Associates May 2022 study of 182 Medicare supplement insurance carriers, approximately 9.90% of plans currently in-force are Plan N.  This falls in-line with the data from the National Association of Insurance Commissioners (NAIC) showing that Plan N accounts for over 10% of Medicare supplement plans purchased since 2017.  Recent data shows Medigap Plan N is approaching 20% of all Medicare Medicare supplement plan sales.

 As of 2020 64% of insurance companies that offer Medicare supplements offer a Medigap Plan N. That figure is up from 54% in 2016. (source AHIP 03/2022 Trends in Enrollment) This compares to 73% who offer the Plan G, the most popular Medicare supplement plan among those who are new to Medicare. This makes Medigap Plan N the second most popular of all Medigap Plans for those new to Medicare in the United States.

Are All Medicare Supplement Plan N The Same?

Yes, the benefits offered by all Medicare Plan N policies are the same. This is what we mean by “Standardized”. Medicare supplement standardization was part of the 2010 Modernization Act and covers all supplement policies currently available.

Even though the benefits are standardized, the policy premiums are not. Premiums can vary wildly from state to state and from one insurance company to another. This is true with all Medicare supplement insurance plans and is covered in detail below.  You will find, however, more positives than negatives when you research Medicare Plan N reviews.  

What Does Medicare Supplement Plan N Cover?

1. Medicare supplement plan N pays the copays and deductibles of Medicare Part A inpatient care so that the Medicare beneficiary can spend up to a year as a inpatient in the hospital without spending a dime.

2. Medigap Plan N will pay the 20% coinsurance not paid by Medicare Part B for outpatient and physician services. Medicare pays 80%, Medicare supplement plan N pays 20% Part B coinsurance.

3. Medigap Plan N pays the Skilled Nursing facility coinsurance so the beneficiary can spend up to 100-days in a skilled nursing facility without out-of-pocket expenses for medical bills. This is equal to the best skilled nursing facility care available from any supplement.

4. Medicare supplement Plan N will 80% of Foreign travel emergency care, up to a lifetime maximum of $50,000. The Medigap plan pays after a $250 deductible.

5. Plan N will also pay up to the first three pints of blood per calendar year. Oddly, Medicare does not cover the first three pints of blood needed during a calendar year. The supplement Plan N steps in and pays this “vampire deductible” for the policy holder.

6. Medicare’s intent is to cover all medically necessary medical services. If Medicare covers a service or procedure, your supplement insurance will pay its portion.

What Does Medicare Supplement Plan N Not Cover?

In general, a Medicare supplement insurance plan will not pay for long-term care because Original Medicare does not cover long-term care. Medicare supplements do not pay for services not offered by Original Medicare. As such, corrective vision treatment such as eye exams, glasses and contacts are not covered services. Neither is routine dental care, hearing aids and tests, or private-duty nursing.  Because they are not a Medicare health care option, they are not a Medicare supplement plan option.

Your Medicare supplement insurance plan N will also not pay for Part B excess charges. This is covered in detail below.  As of 2020, I know of no major hospital organizations that charge Medicare Excess Charges for outpatient services.  There are no inpatient excess charges.  

Medicare Part B Annual Deductible

Medigap Plan N does not cover the Medicare Part B annual deductible. Many people believe the Medicare supplement Plan N has a deductible. It does not. It’s simply that the Medigap plan does not cover Medicare’s annual Part B deductible, which is currently under $250 for the year.

Plan N Office Visit and Emergency Room Copay

Medicare supplement Plan N has an office visit and emergency room copay. It’s the only Medicare supplement plan to have this feature. When you visit a doctor for an evaluation or diagnosis, Plan N can have a copay of 20% of the office charge, up to a maximum if $20. Technically that is a coinsurance, but because the dollar amount is so small it’s most often referred to as a copay.

Emergency room visits can result in a $50 copay. However, if emergency room visits result in an inpatient admission, the $50 copay is waived. This is because once a person is placed under inpatient admission their Medicare billing is switched to Part A. To be clear, an emergency room visit that does not result in an inpatient stay at a hospital will be subject to a $50 copay. Keep in mind, you can be held overnight in a hospital outpatient services, which is covered by Part B.

It should be noted that unlike most insurance copays, the Medigap Plan N copay is not typically paid at the time of service. It’s more common to have the copay listed on a medical bill. This is because the copay is not a flat $20. It is is 20% up to a maximum of $20. Most of the time, the office staff will not know if your office visit will be the maximum $20, or something less. If the doctor’s office neglects to collect the copay during your office visit do not be concerned. You can expect it to show up in your bill.

Medicare Billing Changes Post Pandemic

It used to be that there were no office visit copays for telehealth or urgent care visits. However, that changed with the Covid-19 pandemic. With changes in the way that medical care is delivered came changes in billing. As of 2020, both telehealth and urgent care visits can be billed using CPT codes 99201 through 99205, resulting in a Plan N office visit copay.

Still, not all office visits will result in a Plan N coinsurance charge. The office visits must be for either diagnosis or evaluation. For example, flu shots or chemotherapy will not result in a Plan N copay, although Plan N will pay the Medicare Part B coinsurance and hospital costs.

Does Medicare Plan N Cover Physical Therapy?

It’s important to understand that Plan N, like all Medicare supplement plans, does not make decisions on what is or is not covered. Medicare’s intent is to cover services that are medically necessary and relies on your doctor to help determine medical necessity. If Medicare covers a procedure, your Medicare supplement will pay the copay or deductibles as required by the plan benefit design.

Medicare should cover physical therapy as an outpatient service. When it does, the 80% Medicare Part B responsibility is covered by Medicare. Medigap Plan N will pay the remaining 20% Medicare Part B coinsurance.

Because physical therapy sessions are neither a diagnosis or evaluation, it is not subject to the Plan N copay. There is no Plan N copay for physical therapy.

What Are Part B Excess Charges

Everyone with original Medicare as their primary insurance should understand Part B excess charges and how they can influence your office visit billing. If your primary insurance is a Medicare Advantage plan you will not need to concern yourself because excess charges are not allowed with Medicare Advantage plans.

Medicare  Part B excess charges are commonly referred to as balance billing. It is when a doctor is allowed to bill the patient an amount great that the Medicare approved amount for a service or procedure. Balance billing is only allowed by medical providers that have a specific contract with Medicare, and only for outpatient services.

What Is a Participating Medical Provider?

When a medical professional decides they want to work with Medicare they can choose one of two annual contracts. They can either be a Participating Provider or a Non-Participating Provider.

A Participating Provider agrees to accept only the Medicare approved amount for a service or procedure. They also agree to bill Medicare directly and not the patient. This is agreement is often referred to as Medicare assignment. The Participating Provider is a doctor that accepts Medicare assignment.

By contract with Medicare, the Participating Provider cannot charge an excess charge. If your doctor accepts Medicare assignment, they cannot charge an excess charge.

As a reward for accepting Medicare assignment, Medicare will be the doctor’s one-stop biller. The doctor bills Medicare only. Medicare will pay its share, usually within weeks. Medicare will then electronically communicate to the Medigap plan and instruct the plan on what to pay, when and to whom. The doctor never bills the Medicare supplement insurance plan.

This is why the doctor’s office will accept any of the Medigap Plans from any insurance company. They don’t bill the supplement.

What Is a Non-Participating Medical Provider

When a doctor wants to bill the patient more than the Medicare assignment rate, they will choose a contract with Medicare as a Non-Participating Provider. A non-participating provider does not have to accept Medicare assignment  and can charge excess charges..

The non-participating contract allows the doctor to charge up to a maximum of 15% more than the Medicare approved rate for covered services.

Medicare discourages doctors from becoming non-participating by penalizing them in a few ways. First, they will pay the doctor 5% less than they pay the Participating provider. Second, the doctor can then only bill a maximum of 15% more than the lower rate. As a result, the doctor will receive only 9.25% more than if they accepted assignment.

The most important “penalty” is that Medicare will not be the one-stop biller for the Non-Participating medical provider. The doctor’s office still must bill Medicare, but Medicare will not communicate the bill to the Medigap plans. Because the doctor does not have a contract with the Medigap plans, they cannot bill them either. Instead, they typically ask the patient to pay for services in advance, then reach out to the supplement insurance company for reimbursement.

Only a non-participating provider can charge an excess charge. But they do not have to. In fact, you can negotiate with the doctor to only charge you Medicare’s assigned rate.

Plan N does not cover Part B excess charges.

Neither Medicare Part B nor Medicare Plan N will insure you for excess charges. This is important. If you have a Plan N you must check ahead of time to make certain you medical provider does not charge an excess charge.

Can Excess Charges Be Charged in an Emergency?

Emergency care is exempt from balance billing. You cannot be charged an excess charge for emergency care treatment.

How can I tell if my doctor will charge an excess charge?

You can use the Providers & Services search tool on Medicare.gov to see if your doctor accepts Medicare assignment or not. In addition, if your medical provider asks you to pay upfront and be reimbursed by your Medigap plan N, you can be assured they can charge an excess charge.

Other Medicare supplement plans like Plan G and Plan F will pay excess charges if they are billed to you. Either is a good option for those that are concerned about excess charges.

How Common are Part B Excess Charges

Part B excess charges are very uncommon. Most people will never come across a doctor that charges an excess charge during their entire Medicare experience. According to KFF.org, only 3% of the doctors that work with Medicare have a contract that allows them to charge an excess charge. Of that 3%, nearly half are mental health professionals.

How Often Do Doctors Charge Medicare Excess charges?

A medical provider that can charge an excess charge will likely do so, unless the patient has negotiated another arrangement.

What states do not allow Part B Excess charges?

There Are Eight States That Prohibit Medicare Excess Charges

• Connecticut,

• Massachusetts,

• Minnesota,

• New York,

• Ohio,

• Pennsylvania,

• Rhode Island, and.

• Vermont.

Residents of these states cannot be charged an excess charge for services rendered in their state. However, some states will allow for excess charges to be billed to out-of-state residents.

Massachusetts, Minnesota & Wisconsin

Because Massachusetts, Minnesota and Wisconsin have opted out of the federally standardized Medicare supplement program, beneficiaries in those states cannot technically purchase a federally standardized Plan N. However, residents of Minnesota or Wisconsin will be able to purchase a supplement that is nearly identical.

What is the Maximum Out-of-Pocket for Medigap Plan N?

All Medicare supplement plans have maximum out-of-pocket expenses. In fact, the maximum out-of-pocket limits for the most common supplement plans are substantially less than available through Medicare Advantage plans.  That is one reason why Medicare supplement plan reviews are so positive. 

I have written a blog post and published a video that goes into detail about the maximum out-of-pocket risk for each supplement plan.

Plan N’s maximum out-of-pocket is equal to the amount of the Medicare Part B deductible plus the office visit copays experienced during the year. To have a maximum out-of-pocket for Plan N, we must consider the patient will simply avoid excess charges.

How Much Does Medicare Supplement Plan N Cost?

In most states, the monthly premium of any Medicare supplement plan will depend on your age, gender, and if you use tobacco products. In addition, prices for the same plan will vary significantly by insurance company.

Because we work with people in every state, we have a good idea of Medicare plan prices and how they differ from on state to another.

Some states have Medigap Plan N offered to people at age 65 with monthly premiums under $75 / month. In other states you can find monthly premiums for Plan N from $150 to $180 a month.

How Can a Licensed Insurance Agency Help Me?

The best way to find out what a Plan N will cost you is to request a free Medicare supplement quote. We will email you the prices of the popular Medicare supplement plans in your area. It cost you nothing and you are under no obligation.

Is Plan N Better Than Medigap Plan G?

Plan G offers more Medicare benefits than a Plan N. But the Plan G monthly premium is higher than Plan N monthly premium and has a history of higher price increases. If money is not a concern, then Plan G can certainly be a better option. It is what we call the “peace of mind plan.” But if the monthly premiums are as much an issue as Medigap benefits, compare Medigap Plan G premiums to Plan N premiums.

We use a simple value protocol to help people decide which is the best Medicare supplement for them.  Medicare supplement Plan N tends to be the best value. 

When Can I Enroll in Plan N?

The best time to enroll in a supplement plan is during your Medicare Supplement Initial Enrollment Period. This is the first six months on Medicare Part B. After that six-month window you can expect to be required to qualify via medical underwriting in order to purchase a supplement plan. Some states offer exceptions to this rule.