Medicare Supplemental Plan N: Your In-Depth Guide

If you’re approaching Medicare or already enrolled, you may be familiar with the concept of Medicare Supplement Insurance (often called Medigap). These supplemental plans are designed to fill in the “gaps” left by Original Medicare (Parts A and B), helping to lower your out-of-pocket healthcare expenses. Among the ten standardized Medigap options, Medicare Supplemental Plan N has gained popularity for its balance between monthly premiums and out-of-pocket costs. But is it right for you?

In this comprehensive guide, we’ll delve into the ins and outs of Medicare Supplemental Plan N. We’ll break down how it works, compare it to other Medigap plans, provide cost considerations, and share real-world feedback. By the end, you’ll have a clear sense of whether Plan N aligns with your health and budget needs.

Medicare Basics: Where Plan N Fits

Original Medicare at a Glance

• Medicare Part A: Covers hospital stays, skilled nursing facility care, home health services, and hospice. Most beneficiaries don’t pay a monthly premium for Part A, assuming they’ve paid Medicare taxes for at least 10 years.
• Medicare Part B: Covers doctor visits, outpatient procedures, preventive care, and medical supplies. Part B requires a monthly premium, and you share costs through deductibles and coinsurance.

Although Original Medicare provides broad coverage, it doesn’t pay for everything. You’ll still face:

• Part A deductible and coinsurance for long hospital stays.
• Part B coinsurance (usually 20% of Medicare-approved amounts).
• No limit on out-of-pocket costs.

Supplemental Insurance (Medigap)

This is where Medigap—or Medicare Supplement Insurance—steps in. These policies help cover out-of-pocket expenses like deductibles, copays, and coinsurance. Private insurance companies offer these plans; however, they’re standardized by the government. That means Medicare Supplemental Plan N from one insurer must include the same basic benefits as Plan N from another insurer in states where it’s offered (excluding Massachusetts, Minnesota, and Wisconsin, which have their own standardized plans).

What Is Medicare Supplemental Plan N?

Medicare Supplemental Plan N is one of the standardized Medigap policies introduced in 2010. It quickly gained attention for its typically lower monthly premiums than some of the more comprehensive Medigap plans, such as Plans F or G. The trade-off? You might have slightly more out-of-pocket expenses when you use healthcare services.

In essence, Plan N can be considered a “cost-sharing” Medigap plan. The insurance company pays a significant portion of your Part A and Part B costs, while you’re responsible for specific copays or coinsurance in certain situations. Despite some cost-sharing, Plan N still provides robust coverage—especially for hospital-related expenses under Part A.

Plan N vs. Other Medigap Plans

To decide if Medicare Supplemental Plan N is right for you, it helps to see how it stacks up against the other most popular Medigap plans, notably Plan G and Plan F.

Plan N vs. Plan G

• Medicare Part A Deductible: Both Plan N and Plan G cover the Part A deductible in full.
• Medicare Part B Deductible: Neither Plan N nor Plan G covers the Part B deductible (which is $226 in 2023), so you pay that amount out of pocket.
• Part B Excess Charges: Plan G covers excess charges (when doctors charge up to 15% above the Medicare-approved amount), while Plan N does not.
• Copays: With Plan N, you may have copays for office visits and emergency room (ER) visits. Plan G typically does not require copays for these services.

Plan N vs. Plan F

• Plan F is the most comprehensive Medigap plan. It covers the Part A and Part B deductibles, coinsurance, and even Part B excess charges.
• Plan N involves copays for Part B visits and does not cover Part B excess charges or the Part B deductible.
• Plan F is no longer available to new Medicare beneficiaries who became eligible on or after January 1, 2020. If you were eligible for Medicare before 2020, you can still enroll in Plan F if it’s available in your state.

If you want robust coverage but can handle occasional copays and the Part B deductible, Plan N might be a cost-effective alternative to Plan G. If you want the most comprehensive coverage possible (and you’re eligible), Plan F could be ideal—though it comes with higher premiums, and many people can’t sign up for it anymore.

Coverage Details: What Plan N Pays For

Despite having some cost-sharing, Plan N covers a wide range of healthcare expenses. The list below outlines what’s fully or partially covered:

1. Medicare Part A Coinsurance and Hospital Costs
   • Covers up to an additional 365 days after Medicare benefits are used up.
2. Medicare Part A Deductible
   • Plan N pays the Part A deductible (which is $1,600 in 2023) for each benefit period.
3. Part A Hospice Care Coinsurance or Copayment
   • You have 100% coverage for hospice care coinsurance or copayments.
4. Skilled Nursing Facility (SNF) Coinsurance
   • Covers coinsurance from days 21 to 100 in a skilled nursing facility.
5. Medicare Part B Coinsurance or Copayment
   • Except for certain copays ($20 for some office visits, up to $50 for ER visits—if you’re not admitted).
6. First Three Pints of Blood
   • After you meet your Part B deductible, Plan N covers the cost of the first three pints of blood each year.

What Plan N Does NOT Cover

• Part B Deductible: You pay this out of pocket.
• Part B Excess Charges: If your provider does not accept Medicare’s “assignment,” they can charge you up to 15% more than the Medicare-approved rate in most states. Plan N does not cover these charges.
• Foreign Travel: While many Medigap plans include limited coverage for emergency travel abroad, Plan N typically offers 80% coverage after a $250 deductible, up to plan limits. Always confirm these details with your insurer.

Out-of-Pocket Costs to Expect

While Plan N can lower your monthly premium compared to Plans F or G, you’ll pay for some services as you use them. Here are the common out-of-pocket costs:

1. Medicare Part B Deductible
   • You’ll be responsible for the first $226 (in 2023) before Plan N starts covering Part B services.
2. Copays for Doctor Visits
   • Up to $20 for some office visits. Note that many preventive visits are $0 if your doctor accepts Medicare assignment.
3. Copays for Emergency Room Visits
   • Up to $50 for ER visits if you’re not admitted to the hospital.
4. Excess Charges (if applicable)
   • If your provider charges more than the Medicare-approved amount, you pay the difference.

Balancing Premiums with Cost-Sharing

The main advantage of these cost-sharing features is lower monthly premiums than some other Medigap plans. If you’re in good health or generally use fewer medical services, those small copays can be a fair trade for a reduced premium. However, if you frequently see specialists or worry about excess charges, you might compare Plan N to Plan G or Plan F (if eligible).

Pros & Cons of Plan N

Like any insurance option, Medicare Supplemental Plan N has its advantages and disadvantages. Here’s a quick look at the key points:

Pros

1. Lower Monthly Premiums
   • Often cheaper than Plans F and G, making it appealing if you have a tight budget.
2. Comprehensive Hospital Coverage
   • Covers your Part A deductible in full and offers robust hospital cost protection.
3. Predictable Copays
   • The $20 and $50 copays are relatively straightforward, so you know what to expect.

Cons

1. No Coverage for Part B Excess Charges
   • If you see providers who charge above Medicare-approved amounts, you could face significant out-of-pocket costs.
2. Copays for Doctor and ER Visits
   • If you frequently visit the doctor or ER, these costs can add up quickly.
3. Doesn’t Cover Part B Deductible
   • You’ll still be responsible for paying the Part B deductible every year.

Overall, Plan N’s appeal lies in its balance between affordable premiums and moderate cost-sharing. If you’re relatively healthy, you may find that you save money by avoiding the higher premiums of more comprehensive plans.

Reviews and Real-World Feedback

Choosing a Medigap plan is a big decision—so it can help to hear from real beneficiaries. While everyone’s experience is unique, here are a few trends commonly reported about Plan N:

1. Lower Premiums, Higher Satisfaction
   • Many Plan N enrollees report significant savings on monthly premiums compared to Plan G or Plan F. This can be especially appealing for people on fixed incomes.
2. Minimal Surprises with Copays
   • Plan N’s $20 and $50 copays are easy to budget for, and many beneficiaries find they don’t mind paying them occasionally.
3. Beware of Excess Charges
   • Some beneficiaries in states where excess charges are common (like Texas) note that they switched from Plan N to Plan G to avoid high out-of-pocket surprises. However, certain states (e.g., Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont) have laws that limit or prohibit Part B excess charges.
4. Good Fit for Healthy Retirees
   • If you rarely need to see specialists or have advanced medical needs, the occasional copay is often cheaper than a higher monthly premium.

Of course, your mileage may vary. If you anticipate frequent doctor visits or surgeries, those copays (and the possibility of excess charges) might make Plan G a better long-term strategy.

Enrollment Guidelines and Eligibility

Plan N is available to anyone enrolled in Medicare Part A and Part B. However, the best time to buy a Medigap policy is during your Medigap Open Enrollment Period:

1. Six-Month Window
   • Starts the month you turn 65 (and are enrolled in Part B).
   • During this time, you can buy any Medigap policy sold in your state without medical underwriting.
2. Guaranteed Issue Rights
   • In specific situations (like losing employer coverage or moving out of a plan’s service area), you may have guaranteed issue rights that let you enroll in a Medigap plan without denial or higher premiums due to pre-existing conditions.

Once this window closes, you can still apply for Plan N at any time, but insurers may deny coverage or charge higher premiums based on your health status. If you anticipate the need for a Medigap plan, enrolling during your open enrollment or a guaranteed-issue situation can save you hassle and money.

Frequently Asked Questions (FAQ)

1. Will Plan N cover all my hospital costs?
   Yes. Plan N fully covers Part A coinsurance and the Part A deductible, which means your hospital stays are typically covered after Original Medicare. However, always confirm with your insurer if there are any specific limitations.
2. How do I avoid Part B excess charges with Plan N?
   You can avoid Part B excess charges by visiting doctors who accept Medicare assignment (i.e., they agree to charge only the Medicare-approved rate). If you’re unsure, call the doctor’s office and ask about their billing practices.
3. Are my copays for doctor visits guaranteed to be $20 every time?
   Plan N sets up to $20 for certain Part B office visits, not necessarily every visit. Often, preventive care visits are $0, and some specialists might charge less than $20. Confirm these details with your insurer.
4. Does Plan N include prescription drug coverage?
   No. Like most Medigap plans, Plan N does not include Part D prescription drug coverage. You’ll need a standalone Part D plan if you want help covering your medications.
5. Can I switch from Plan N to Plan G later on?
   Potentially. However, if you’re outside your Medigap Open Enrollment Period or don’t have a guaranteed issue right, you might need to undergo medical underwriting, which can lead to higher premiums or denial based on your health status.
6. What if I travel internationally?
   Plan N includes foreign travel emergency coverage in many states—typically up to 80% of your costs after a $250 deductible, with a lifetime limit of $50,000. Double-check your policy’s specific terms to avoid any surprises abroad.

References

1. Medicare.gov – www.medicare.gov
   • Official U.S. government site for Medicare details, including plan comparisons and coverage guidelines.
2. Centers for Medicare & Medicaid Services (CMS) – www.cms.gov
   • Provides regulatory information and updates on Medigap standardization.
3. Medigap Policy Comparison – Medicare Publication
   • Official guide to choosing a Medigap policy; offers side-by-side plan comparisons.
4. National Association of Insurance Commissioners (NAIC) – www.naic.org
   • Offers guidance on state-specific Medigap regulations.

Wrapping Up

Medicare Supplemental Plan N is an attractive option for many Medicare beneficiaries looking to keep their monthly premiums manageable while still enjoying robust coverage for hospital stays, skilled nursing care, and much of Part B’s coinsurance. By accepting limited cost-sharing—such as copays for doctor and ER visits—you could save significantly on monthly premiums compared to Plans F or G. However, the possibility of Part B excess charges (if you see providers who don’t accept Medicare assignment) is a potential drawback.

Ultimately, the decision hinges on your healthcare needs, provider choices, and comfort level with occasional out-of-pocket expenses. If your doctors accept Medicare assignment and you don’t anticipate frequent specialist visits, Plan N could provide an ideal balance between coverage and affordability. For those concerned about every potential out-of-pocket cost, Plan G or even Plan F (if eligible) may offer more peace of mind—though at a higher monthly price.

Remember: Once your six-month Medigap Open Enrollment Period ends, you may face underwriting, so timing matters. If Plan N feels right for you, enrolling during that window ensures you’ll lock in coverage without the headache of medical questionnaires or risk of denial. Above all, take a close look at your healthcare usage patterns and budget before making a final decision. A little research now can lead to big savings (and greater peace of mind) down the road.