Medicare Plan N is also called Medigap Plan N and is optional supplemental insurance for people with Original Medicare Parts A and B. Additional insurance options provide coverage for charges that original Medicare doesn’t cover. Plan N is a popular Medigap option because of its low price, but it’s not available to everyone and includes a co-payment feature.
How Medigap Plan N Works
Medicare Parts A and B cover about 80% of medical expenses. Part A focuses on hospitalization and inpatient care, while Part B handles outpatient services. The remaining expenses are classified as gaps in coverage. Adding a supplemental Medigap plan reduces or eliminates the remaining costs, thereby filling in the gaps.
To qualify for Medigap, you must have Original Medicare as these policies do not apply to those with Medicare Advantage. Medicare Advantage functions similarly to Network Insurance, with select doctors available to participate. In contrast, Original Medicare applies to any doctor or hospital.
With Original Medicare, the patient pays 20% of the approved amount. Adding supplemental insurance, like Plan N, can eliminate those expenses.
What Does Medicare Supplement Plan N Cover?
| Benefits | Plan N | Plan A | Plan B | Plan C | Plan D | Plan F | Plan G | Plan K | Plan L | Plan M |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part B coinsurance or copayment | 100% coinsurance; but copays may still apply | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes |
| Part A deductible | Yes | Not covered | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% |
| Part B deductible | Not covered | Not covered | Not covered | Yes | Not covered | Yes | Not covered | Not covered | Not covered | Not covered |
| Part B excess charge | Not covered | Not covered | Not covered | Not covered | Not covered | Yes | 100% | Not covered | Not covered | Not covered |
| Out-of-pocket limit | N/A | N/A | N/A | N/A | N/A | N/A | N/A | $6,940 in 2023 | $3,470 in 2023 | N/A |
| Blood (first three pints) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes |
| Skilled nursing facility care coinsurance | Yes | Not covered | Not covered | Yes | Yes | Yes | Yes | 50% | 75% | Yes |
| Foreign travel exchange up to plan limits | 80% | Not covered | Not covered | 80% | 80% | 80% | 80% | Not covered | Not covered | 80% |
Medigap Plan N pays some patient expenses for people with Original Medicare. Original Medicare pays 80% of the approved charges, and Plan N covers the balance after the patient makes a co-payment. Policyholders spend $20 for each doctor visit and $50 for an emergency room visit that doesn’t end up in hospitalization. Any expenses not covered by Medicare then become the responsibility of the patient.
Many people opt for Plan N because it has a relatively low monthly cost, roughly between $120 and $180. It also offers additional coverage for people concerned about their health care expenses.
One of the differences between other supplemental policies is that private insurance companies sell Medigap N. Therefore, one can expect some differences in policies from state to state. Plan N has low monthly premiums and co-payments by design. Another option is Plan G which costs more monthly but offers more comprehensive coverage.
Plan G is similar to Plan N, but the monthly payment is higher, and its coverage is more comprehensive.
What Medicare Supplement Plan N Does Not Cover
Plan N does not cover costs that are considered excess charges. Excess charges occur when a patient sees a doctor or provider who does not accept Medicare assignments. Therefore those providers do not lower their rates to the approved Medicare amounts. In this situation, Medicare and Plan N will pay up to the approved amounts, with the patient covering extra charges.
Medicare Supplement Plan N Eligibility
Medigap Plan N is for people who enrolled in Original Medicare and became eligible for Medicare after January 1, 2020. If eligibility was before that date, then Plans C, F, and high-deductible F are the available Medigap policies.
Plan N vs. Other Medigap Options
Medigap Plan N provides near-inclusive coverage, paying for all of the patient’s out-of-pocket expenses, except for the deductibles. Medigap Plan N also offers low monthly premiums and extensive coverage, making it a popular option for those that qualify.
Plan N is a good option for budget-minded people who do not visit the doctor often. The co-pay amounts are inexpensive with Plan N. However, for those who go to the doctor weekly, another Medigap plan might be a better option.
Plan N vs. Plan G
Many people compare Plan N with Plan G. However, some distinctions exist. Plan G is generally more inclusive but demands a higher monthly premium. For example, Plan G does not have co-payments, while plan N does. Plan G covers any excess Part B expenses, whereas Plan N does not.
Plan N vs. Plan F
Anyone eligible for Medicare before January 1, 2020, can continuously qualify for Medigap Plan F. These people could also switch to Plan N. Still, it is in their best interest to hold onto Plan F as it offers more coverage. The primary difference between these plans is that F covers more out-of-pocket expenses and pays the Part B annual deductible, while Plan N does not.
Plan N vs. Medicare Advantage
If someone has selected Medicare Advantage over Original Medicare, they cannot enroll in Plan N. Therefore, one must decide between Original Medicare with a supplemental Medigap policy and Medicare Advantage.
The primary differences between original Medicare and Medicare Advantage pertain to coverage and restrictions on health care professionals. Medicare Part A is complimentary, while Part B has a premium. However, that premium is less than most Medicare Advantage options. For many people, Parts A and B do not cover enough of their expenses, and they opt for Medigap plans, like Plan N, to fill in and pay some extra costs. With the Medigap plans comes additional monthly premiums.
Medicare Advantage has fewer gaps than Original Medicare and includes vision and dental in many situations. It has a higher monthly fee but can be less expensive due to the added coverage, depending on the individual and their healthcare needs.
Medicare Advantage only allows one to visit specific providers, similar to network insurance.
This feature is crucial for people who do not live where there are many in-network providers or for someone who wants the freedom to select any doctor.
How to Enroll in Medigap Plan N
There are three enrollment periods for Medicare. The first occurs when someone becomes eligible for Medicare. There is also an open enrollment period from October 15 to December 7 in which people enrolled in Medicare can join, switch or drop a plan. The third is a Medicare Advantage open enrollment period from January 1 to March 31 each year, where you can change Advantage plans or opt for Original Medicare.
Some special enrollment periods don’t have set dates. Instead, individual circumstances trigger them.
Individual Initial Enrollment Period
- When: Initial enrollment is a seven-month window for everyone approaching age 65 in which they can sign up for Medicare. The window begins three months before their 65th birthday and extends three months after that.
- What Can You Do: If you are already getting social security, then enrollment is automatic. If someone is still working, there may be an option of continuing with that insurance rather than taking Medicare.
Starting Medicare at 65 is the best time to select optional supplement plans. Generally, qualifying factors for supplemental plans include age and health status, with younger individuals enjoying cheaper plans.
Medicare Open Enrollment Period
- When: Open enrollment occurs annually from October 15 to December 7 and new coverage will begin on January 1 of the following year.
- What Can You Do: During this time, people can change from Original Medicare to a Medicare Advantage Plan or vice versa. They can also change from one Advantage plan to another, join a Medicare drug plan, or switch or drop drug plans.
Medicare Advantage open enrollment occurs between January 1 to March 31 annually for people who already have Advantage and want to make a change.
Special Enrollment Periods
- When: Certain events trigger Special enrollment periods, so they have no pre-specified enrollment dates. The most common is moving, losing current coverage, being offered other insurance coverage, or changing the plan’s Medicare contract.
- What You Can Do: If one of these special circumstances occurs, the insured will enter a Special Enrollment Period or SEP. If a change is wanted or necessary, the individual can contact 1-800-MEDICARE or connect with their Medicare Advantage private insurance provider to learn about the next steps.
In most situations, the SEP lasts two months after the qualifying circumstance and may begin before the event. It’s important to manage these changes and enroll in a new plan or risk having a gap in coverage and being personally responsible for all medical bills.