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Songer Benefits, Inc. Blog

All You Ever Wanted to Know About Insurance

Medicare Supplement Plan N

Medicare Supplement Plan N, also called Medigap Plan N; was created for Medicare beneficiaries who liked the idea of paying a lower monthly premium in exchange for taking on a small annual deductible and some copays when Plan F was discontinued for new Medicare beneficiaries as of 2020 Plan N has quickly become the runner up for the most popular Medigap plan following Plan G.

Your Medicare part A hospital benefits provide coverage for inpatient hospital services, skilled nursing, home health, Hospice, and blood transfusions. While you would typically have a deductible for your hospital stay, which is $1556 in 2022, your Medigap plan end will pay that. Medigap Plan N also covers other inpatient services, such as your daily hospital copays, skilled nursing facility care, hospice care, and coverage for your first 3 pints of blood if a blood transmission is necessary. Plan N even covers foreign travel emergency benefits up to the plan's limits. Your standard preventative care is covered entirely by Medicare; this includes screenings for cancer, diabetes, and cardiovascular conditions. It also includes annual Wellness visits, colonoscopies, vaccines, and other routine tests. 

You will pay nothing for any of the standard Medicare Preventive care services. Medigap plans, like Plan N, cover your share of non-preventive health care services under Medicare Part B. So, your supplement plan and coverage will include coverage for visits to the doctor for an injury. And illness is durable medical equipment, ambulance outpatient surgeries, lab work, other imaging tests: diabetes supplies, and many more services. The main thing to remember is that if Medicare Part A or B covers a medical service, your supplement will also cover it. 

A breakdown of what plan and will pay and what you will pay for outpatient services through, plan and cover your hospital deductible. It does not cover your outpatient deductible so you will pay that small and no deductible upfront on your first outpatient service of the year. In 2022, the Part B deductible is $233. Once that is satisfied, you will pay only a copay of up to $20 for doctor visits for the rest of the year. And up to $50 for emergency room visits with plan N outside of those two things, then for everything else under Part B, Original Medicare pays 80% and then sends the remainder of the bill to your plan and insurance company to pay the other 20%, which equals 100% for you. There would be one exception if you were to visit. A non-participating Medicare provider, which is a provider that accepts Medicare but not Medicare, is assigned rates that the provider can charge you and access charge of up to 15% for your health care services in most states. 

Medigap Plan N does not cover Part B. Excess charges like Plan G does. If your doctor does not accept Medicare assignment, you will pay that 15% excess charge in most states, which can sometimes result in relatively small invoices that come in the mail for you to pay. Let's look at an example. Say that Nancy has a plan to end and visits her podiatrist in the middle of the year after her Part B deductible has already been met. Medicare's assigned rate for a visit to this foot specialist is $100. If the doctor does not accept assigned rates, they can balance bill Nancy for up to 15% beyond the approved rate for this visit, or a maximum of $15 in this case. Karen will also pay her doctor copay of up to $20 at the time of services and her Medicare supplement plan and pay the remainder of the approved charges. You can avoid access charges by asking your providers upfront if they accept Medicare. Stick to participating providers, and you won't ever encounter access charges, so that's the tradeoff plan and will typically have lower premiums than the plan G. Still, you are responsible for your doctor's copays, ER, copays. 

You are eligible to enroll in the plan, and if you have Medicare parts A&B, you must also live in the plan's service area. The best time to enroll in Medigap Plan N is during your one-time six-month Medigap open enrollment. This six-month window starts with your Part B effective date on your Medicare card. It's your one chance to enroll in any Medigap plan without health underwriting questions. No insurance company can turn down your Medigap application due to health conditions. If you miss your one-time Medigap open enrollment period, you can still apply for a Medigap plan N. However, you would likely have to undergo medical underwriting in most states. At Songer benefits, we can explore the health questions on various companies' applications to help you see if you can pass the underwriting through Medicare. Plan N is one of the ten federally standardized Medicare supplement options. The policy is relatively easy to find since many carriers offer it. To learn more about the differences between plan G and plan N, give us a call at Songer Benefits.