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Plan N

Medicare Supplement Plan N

Medicare Supplement Plan N has been popular since it was first introduced in 2010. Also called Medigap Plan N, this supplemental option was created for consumers who like the idea of paying a lower premium in exchange for taking on a small annual deductible and some copays.

The Medicare Supplement Plan N is similar to the Plan F however consumers will have more cost sharing. You will be responsible to pay your Medicare Part B deductible ($183 for 2017), you will have co-pays up to $20 for doctor visits, and $50 co-pay for emergency room visits.

Consumers with the Plan N will also be responsible to pay “excess charges” that some doctors may charge. Providers may charge patients up to 15% of what Medicare pays them for the service. However, if the physician accepts Medicare as full payment then you will never have to worry about excess charges. Please feel free to ask us if a provider accepts Medicare as full payment.

Plan N – Let’s look at an Example

Mary tells her agent that she visits the doctor only once or twice a year. She feels that a full coverage Plan F isn’t really necessary due to her low usage. Her agent explains that Plan N has premiums that are about 30% less than Medigap F if she would be willing to take on copays for a few minor things.

For inpatient care, Medicare Supplement Plan N fully covers her hospital deductible. For outpatient care, Karen will pay the Part B deductible ($183) upon her first doctor visit of the year. She then pays a co-payment of up to $20 when she sees her physicians during the rest of the year. She may pay an excess charge if her doctor is not a participating Medicare doctor. Let’s look at how these expenses on Plan N might affect her.

Let’s say Mary visits her cardiologist in the middle of the year, after her deductible has already been met. Medicare’s assigned rate for a visit to this specialist is $100. If the doctor does not accept assigned rates, he can balance bill Mary for up to 15% beyond the approved rate for this visit, or a maximum of $15 in this case.

Mary owes her $20 copay, and her supplement will pay the remainder of the approved charges. If you find that Plan N hard to understand because of the excess charges and copays, but you still like the idea of lower premiums, then you might check out Plan G. On Plan G, excess charges are covered by your Medigap plan. On Plan G, your cost-sharing is limited to the Part B deductible only.

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