Medicare Supplement Plan N Vs Plan G
As I write this article in mid-2022, Medicare supplement Plan N is one of the two most popular Medicare supplement plans for people new to Medicare. It is the Medicare supplement often considered to be the best value of all the Medicare supplement insurance plans. For those who are value oriented, this article provides a wealth of information on the pros and cons of Medigap Plan N.
In this article, we will start with what you need to know about Medicare supplement plans in general. Then we will review the pros and cons of Medigap Plan N and how to compare Medicare Plan N vs Plan G.
Of course, there is more than one way to skin a cat. (Why someone would want to skin a cat is beyond me, but anyway…) If you are stuck between choosing a Medicare supplement Plan N or Medigap Plan G, please take a look at the article and video titled Best Medicare Supplement Plan. In that article I approach the choice of comparing Medicare plan choices as an issue of personality. I believe you will enjoy it. I believe it is the best way to be confident in your choice when comparing Medicare supplement plan g vs plan n.
Federal Medicare Program
The Medicare program is health insurance for people 65 and older as well as under 65 and disabled. While the program administers Medicare A & B, Medicare supplement plans (aka Medigap plans) are offered by private insurers. They are not available to people under 65 in all states.
Medigap or Supplement, Terminology
There is more than one way to refer to Medigap coverage. You will read the terms Medigap Plan N, Medicare Plan N, Medicare supplement Plan N or Supplemental Plan N. Each of these terms refers to the exact same thing, Medicare supplement Plan N, a supplement to Original Medicare administered by private insurance companies.
Choosing a Medigap Plan
Choosing which Medicare supplement is right for you can be a bit daunting. Certainly, when you are new to Medicare and just learning the terminology and ABC’s of Medicare coverage, making sure you choose the right Medicare supplement is just a little added stress.
So, first off, let me take some of that stress away with a Medicare secret: regardless of your health history, you have 6-months where you can change your mind all you want without any consequence if you are new to Medicare. After that 6-month (180-day) initial enrollment period you will need to qualify via medical underwriting for Medigap coverage.
Medigap policies are insurance policies designed to work with your Medicare Part A and Part B. It pays the deductibles and copays that are the patients’ responsibility when you have Medicare Part A and Part B. On our website you can also check Medicare Supplement Plan N review to check which plan fits you the best and explore your Medicare options.
For example, after a small deductible, Medicare Part B pays 80% of your outpatient Medicare bill. You are responsible for the remaining 20%. When you have a Medicare supplement Plan N, your supplement will pay the 20% for you.
If you become an inpatient in the hospital, Original Medicare has a per event deductible of over $1,500 then full coverage for 60-consecutive days. When you have a Medicare supplement plan N you can have a 365-day stay in a hospital and not pay a dime. You have full coverage for hospitalization. This is the same as Medicare supplement Plan G.
How does medicare supplement Plan N compare to Medigap plan G? I help answer that question in my article and video titled the Best Medicare Supplement Plan.
What Are Standardized Medigap Plans
A standardized Medigap insurance policy is designed specifically to work with Medicare Part A and Part B to limit your out-of-pocket expenses.
The Medigap policy is secondary to Original Medicare. That means Medicare pays first, then your Medigap policy pays their portion.
The term “standardized” is very important. It means that the benefits of all Medicare supplement (aka Medigap) Plans are identical regardless of which insurance company you use. For example, all Medigap Plan N’s have the same benefits. All Medigap Plan G’s have the same benefit, and so on.
The benefits of these standardized policies are written into Social Security Law. They cannot be changed except by an act of Congress, signed by the President. This is the exact opposite of a Medicare Advantage Plan. Medicare Advantage Plan benefits change every year.
Guaranteed Renewable Contracts
Medicare supplement policies are also Guaranteed Renewable contracts. Guaranteed renewable means that the benefits are guaranteed to remain the same for as long as you own the policy. No one can change your benefits or cancel your plan. Even if Congress were to change the benefits of the plan type you have, they can’t change your plan. They can only change plans for people in the future.
Once you have a Medicare supplement no one can change your benefits. No one but you can cancel your plan. The only feature that can change from year to year is the price.
Keep in mind, it is the benefits that are standardized, not the price. Current and future prices can vary by more than 100% from one insurance company to another.
One of my favorite questions to answer is “Why buy a Medicare supplement plan instead of a Medicare Advantage plan?”
There are two reasons why. First is because the benefits are standardized and will remain as is for as long as you own the policy. For your benefits never change. Second is that with a Medicare supplement plan you get to keep all the benefits of Original Medicare. Let me elaborate.
Benefits of Original Medicare
Medicare Part A and Part B is also called Original Medicare. When you receive your red, white and blue Medicare card, you have original Medicare. With Original Medicare you can see any medical provider or facility in the country as long as they accept Original Medicare. That is over 95% of all doctors and medical facilities. You have national insurance coverage. In fact, if you develop a medical issue and wish to see a specialist 1,000 miles away, you can. As long as they accept that red, white and blue Medicare card your Medicare bills are covered.
There is no limiting network of providers you are restricted to. You do not have to ask permission or approval from a Primary Care Physician to see a specialist or anyone else.
The second great benefit of Original Medicare is that there is no insurance company between you and your doctor’s decisions. Your doctor does not need to get preapproval to perform a recommended treatment. No insurance company can deny or delay treatment. Your medical decisions are between you and your doctor.
With supplemental insurance you keep the above two benefits of original Medicare. You can see any healthcare provider or facility that accepts original Medicare. Over 97% of healthcare providers accept Medicare. Your medical decisions are guided by you and your doctor. The supplemental coverage has no say in what is or is not covered by your Medicare. In addition, you can limit your potential medical expenses to just a few hundred dollars per year.
What is a Medicare Replacement Policy?
Contrast the above with a Medicare Advantage Plan (aka Medicare Part C). A Medicare Advantage Plan replaces your Original Medicare. You no longer use your red, white and blue card. The insurance company then gets to set their own rules. They are supposed to cover all that Original Medicare covers, but a 2018 report by the Inspector General for Health & Human Services found that you may have to fight for your coverage. That was followed by a 2022 Inspector General Report showing nothing had improved over the past four years. Medicare Part C is supposed to offer comprehensive benefits equal to Part A and B. But their comprehensive coverage is tainted by the motives of a for profit insurance company.
With a Medicare Advantage Plan, Medicare beneficiaries are restricted to the network of doctors contracted with that specific plan. Some plans allow you to use a medical provider out-of-network, but only if that medical provider agrees to accept your insurance. Most will not. They also have higher out of pocket costs when the Medicare beneficiaries need medical care.
Prior Approval Required
In addition, when a doctor advises you to have a treatment or procedure, they must first get approval by the insurance company. In a 2018 report by the Inspector General for Health & Human Services, more than half the recommended procedures are denied or delayed.
Perhaps this is the reason only 46% of medical providers will accept a Medicare Advantage Plan. Even then, they may not accept yours.
It should be noted that because some Part C plans have no monthly premium, some insurance agents refer to them as free Medicare. They are not a free Medicare plan and it is illegal for an agent to use that term.
How do Medicare Supplements Work?
Your Medicare supplement is secondary to Medicare. Also, when you have a Medicare service with a Participating Medicare Provider your medical provider bills Medicare. They want to have your supplement information on record in case of errors, but they only bill Medicare. Because they are not contracted with your supplement insurance, they cannot bill it directly.
Medicare will pay its portion due and at the same time electronically communicate with your Medicare supplement insurance company instructing them on what to pay and to whom. Yes, Medicare will know with whom you have your supplement.
Most of medical bills are paid by the supplement company in just a few days. A couple of the largest insurance companies I work with routinely note to me that over 85% of medical claims are paid within 48-hours.
The bottom line is that the Medicare supplement simply follows Medicare’s direction. A supplement plan pays what they are told to pay and when. They have no say in what is or is not covered by Medicare. Your healthcare is between you and your doctor.
A Medicare supplement simply pays the copays and deductibles of the procedures and services covered by Medicare. Medicare’s goal is to cover everything that is medically necessary. In order to determine medical necessity, they lean on your doctor for guidance. That doesn’t mean they do everything your doctor wants them to do. But it does mean that your doctor does not have to ask permission to perform their duty as your medical provider. There is no “pre-approval” process like there is with Medicare Advantage Plans.
A Medigap plan simply pays the copays and deductibles of the procedures and services covered by Medicare. Medicare’s goal is to cover everything that is medically necessary. In order to determine medical necessity, they lean on your doctor for guidance. That doesn’t mean they do everything your doctor wants them to do. But it does mean that your doctor does not have to ask permission to perform their duty as your medical provider. There is no “pre-approval” process like there is with Medicare Advantage Plans.
You can view and print the Medicare supplement plan benefit table here: https://medigapseminars.com/medigap-benefits/
On this table, the various Medicare supplement plans are listed across the top row. The broad categories of all benefits are listed down the left-hand column. Medicare supplement Plan N covers 100% of everything except the Medicare Part B Annual Deductible and Medicare Part B Excess Charges. In addition, there is up to a $20 copay for outpatient doctor visits for diagnosis or evaluation and up to $50 copay for hospital emergency room visits. If your hospital emergency room visit result in an inpatient admission, the copay is waived. Also, Medicare supplement Plan N does not cover Part B Excess Charges.
The Medicare Part B deductible is an annual deductible. You pay it when you first see a doctor for outpatient services during any calendar year. Once that deductible is paid, you have 100% coverage for inpatient and outpatient services for the rest of the calendar year. It also has 100% coverage for skilled nursing facility care up to 100-days, just like Plan G.
Of course, with all Medicare supplement plans, you will need separate prescription drug coverage. I have created a special website to help with Part D. Please go to PartDShopper.com for more information.
What Are Medicare Part B Excess Charges?
An excess charge is when a medical provider can charge a patient more than the rates schedule set by Medicare. Doctor’s that accept Medicare Assignment cannot charge an excess charge. Only doctors that do not accept Medicare Assignment can charge an excess charge. Whether a doctor can accept Medicare assignment is based on a contract they signed with Medicare. It’s not a random decision that can change from patient to patient.
In brief, only 3 out of 100 medical professionals have a contract that allows them to charge a Medicare Part B Excess Charge. That number is decreasing every year because the Medicare contract penalizes medical providers who whish to charge more than Medicare’s assigned rates.
This means that the probability of ever running into a medical provider that does not accept Medicare assignment is relatively low. Most doctors that charge an excess charge are psychiatrists.
Still, Medigap Plan N has no insurance against excess charges. If you choose a Plan N, it is up to you to avoid excess charges.
Does Your State Outlaw Medicare Excess Charges?
Some states have laws that forbid medical providers from charging excess charges. This makes Plan N an overwhelming value in those states. If you are not sure about your state, please call us. We will let you know.
How to Avoid Medicare Part B Excess Charges
Avoiding Medicare Part B Excess charges is easy. The easiest way is to go to https://www.medicare.gov/ and use their Provider & Services search tool. Doctors that charge the Medicare approved amount are Participating Providers.
Lastly, a common question we receive is a “what if?”. What if I am an inpatient in the hospital and a bunch of doctors see me. Can one of them charge an excess charge?
The short answer is “No”, for two reasons. The first is that there are no Part A (inpatient) excess charges. Second, in any medical facility or medical group the contracting with Medicare is all or none. Either all the medical providers choose to be Participating Providers, or none. They are not allowed to mix and match.
Yes, Medicare supplement plans have a maximum out-of-pocket limit. Although I encourage you to watch the video or read the article linked below on the Maximum out-of-pocket of Medicare supplement plans, here is Plan N’s in brief.
When determining a reasonable maximum out-of-pocket for Medicare Supplement Plan N we assume you avoid Excess Charges. Of course, we also do not have the foresight of how many office visit copays you may have during a calendar year, but we can estimate a maximum.
I have an article and video specific to this subject and why there is so much confusion. Please take a look: Medicare Maximum Out-of-Pocket
The bottom line is that all the popular Medicare supplement plans have a much lower maximum out-of-pocket that any of the Medicare Advantage Plans. With Medicare supplement Plan N can expect to pay the Medicare Part B annual deductible (currently under $250). You can also expect to pay a $20 copay three to five times per year. That would amount to maybe another $100, for a total out-of-pocket of around $350 for the year.
Even if that number is off a little, it most certainly beats the $6,000 to $11,000 out-of-pocket annual maximum of a Medicare Advantage Plan.
The next way to avoid Medicare Part B excess charges is to stop whenever you visit a doctors office and they request you pay upfront.
Medicare Supplement Plan G
When comparing supplement plans you will find that Medigap Plan G has the lowest potential out of pocket costs for medical services for all who are new to Medicare. Unlike Plan N, there are no copays for office visits. Once you have paid the annual Part D deductible, a visit to your doctor’s office is fully covered for any Medicare service.
Medicare Plan N vs Plan G
For inpatient coverage, supplement Plan G vs Plan N are the same. Hospital costs for inpatient services are covered 100%. That includes the hospice care coinsurance. Plan G and Plan N have very few differences. Both limit your potential out of pocket expenses to a small, manageable amount of money.
If you see a doctor frequently you may want to heavily consider Plan G. It has higher premiums than Plan N, but no office visit copays. If you do not see a doctor frequently, Plan N vs Plan G can save money.
All your supplement Medicare options require medical underwriting after you have had Part B for 6-months or 180-calendare day.
High Deductible Medicare
Medicare supplement Plan G is one of two policies that have a high deductible version. The other is Medicare supplement Plan F. Plan F is not available to newly eligible Medicare beneficiaries. When you compare Plan F vs Plan G you will find that the only difference is that Plan F covers the Part B deductible. That is all. Of all the Medicare plans, Plan F has the highest coverage. But newly eligible Medicare participants will find Plan G and Plan N to be a much better value.
When Can I Buy a Medicare Supplement Plan?
In short, you can purchase a Medicare supplement plan any day of the year, 365-days a year. However, there is a catch. First, for a Medicare supplement to provide insurance coverage, the consumer must have Medicare Part A and Medicare Part B. Without Original Medicare, you cannot have a Medicare supplement Plan. Second, your Medicare supplement Initial Enrollment Period is linked to the start date of your Medicare Part B. Not Part A, just Part B.
No matter when your Medicare Part B starts, your Medicare Supplement Initial Enrollment Period is the first six months you have Medicare Part B coverage. During that time period you can apply for any Medicare supplement that is available to you without regard to your medical history. No medical questions will be asked, and you cannot be turned down or charged more due to your medical history.
Warning: some insurance companies consider your Medicare Supplement initial Enrollment Period to be the first six calendar months of your Medicare Part B coverage. But some insurance companies use a 360-day year, which means your Medicare supplement Initial Enrollment Period is only 180-calendat days from your Medicare part B start date.
How Much Does Medicare Supplement Plan N Cost?
Prices on Medicare supplement plan N can vary by 100% or more from one insurance company to another and from one state to another. For example, the price of a Medicare supplement plan N for a 65-year-old in New York or Miami can cost three times more than the same plan in Virginia or the Carolinas.
The same can also be said between insurance companies. The cheapest priced plan in any state can be one third the price of the most expensive plan. There is no difference in Medicare benefits between one insurance company and another, but there is a big difference in premiums. Choosing the right insurance company is important. That is why so many new Medicare beneficiaries use a licensed Medicare agent to help find the right plan and insurance company.
At Medigap Seminars we work hard to help you find the insurance company that is most likely to provide you your lowest premiums over your lifetime. The lowest price over your lifetime is not always today’s cheapest plan.
The Pros of a Medicare supplement are detailed above section titled “Why Buy a Medicare Supplement Plan?” Simply put, it is the best health insurance available in the U.S. for those who are on Medicare.
If there is one “Con” for Medicare supplement Plan N it is the cost. Because Medicare supplement Plan N offers such robust insurance coverage, the monthly premiums are typically higher than other choices. In addition, it is more susceptible to increases in medical costs.
Keep in mind, statistics show that the choice of insurance company will have a greater impact on price over your lifetime than your choice of supplement plan. That is where we come in. We know these companies and their pricing strategies. Avoiding companies with higher expected price increases can save you thousands of dollars over your lifetime.
How We Can Help
Our motto is “Make an informed decision”. Our goal is to offer free Medicare help with the intent to help understand the Medicare program fully and know all your Medicare options. We first review the Medigap Plans available, including comparing Plan G vs Plan N and even Plan F if eligible. We can offer free Medicare help to you because we are paid by whichever insurance company you decide to work with when we help you with the application
In addition, we help our clients avoid the Medicare Mistakes made by so many DIY Medicare beneficiaries.
Call us at 80-847-9680 for personalized assistance.
You can apply for a Medicare supplement any day of the year, 365-days a year. If you are within 6-months or 180-days of your Medicare Part B start date, you can get any Medicare supplement without answering medical questions. Outside of that 6-month window, you can still apply for a policy but may need to qualify medically to be accepted. Several states have exceptions that allow for an annual open enrollment.
No. You must have Medicare Part A and Part B to receive any benefits from a Medicare supplement.
No. Medicare supplement plans pay the copays and deductibles that are the patients’ obligation under Original Medicare. Medicare does not cover dental, vision & hearing except for in cases of disease or injury. Medicare does cover cataracts, glaucoma and so on.
Technically, the Medicare supplement Plan N does not have a deductible. However, it does not insure against the annual Medicare Part B deductible. For the Medicare supplement policy holder, their only Medicare expense for inpatient and outpatient services is the annual Medicare Part B deductible. That deductible is $233 for 2022.
Yes. However, if you currently have a Medicare Advantage Plan, you can only make a change during the Medicare Advantage Open Enrollment Period. Otherwise, you can apply for a Medicare supplement at any time.
I like to measure the value of a Plan N by looking at the monthly premium difference between the Plan G and Plan N. Then divide that difference by $20, the office visit copay. View the difference as “office visits per month”. How many office visits every month will it take for Plan N not to be a better value than Plan G?
KFF.org Medicare Advantage Networks Included 46 Percent of Physicians in a County, on Average. Published October 2017