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The Case For Plan N Supplemental Insurance

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Plan N Medicare Supplement InsuranceIf you’re shopping for Medicare supplement insurance, Plan N might be a good option. With all Medigap coverage, you are weighing benefits vs. premiums.

It’s important to know that the gaps uncovered by Plan N are small. Rarely do they expose you to significant out-of-pocket yearly expenses.

Plan N does not cover three gaps. Below, we will explain the out-of-pocket costs and exposure associated with each one.

Understanding The Plan N Out Of Pocket Gaps

First, let’s examine the three gaps in Original Medicare that Plan N does not cover. They are:

  • Part B Coinsurance (Plan N has a $20 doctor’s office copay and a $50 emergency room copay)
  • Plan N does not cover the Part B deductible
  • Plan N does not cover Part B Excess Charges

Those are the only gaps not covered by Plan N.  It’s important to know that your out-of-pocket exposure is low and predictable with these three benefits.

Plan N Medicare Supplement Has Doctor’s Office Copays

Plan N is unique because it’s the only Medicare supplement with doctor’s office and emergency room copays. This means you may be responsible for a small copy when you visit your primary care doctor or any specialist. In this way, Plan N is like traditional health plans you see before age 65 that require copays at the doctor’s office.

The Plan N copay is $20 for a doctor’s office visit – and $50 for the emergency room. These fixed amounts have not increased or decreased since the inception of Plan N in 2010. Medicare (CMS) could choose to change these amounts in the future, but it’s unlikely they will. If they do, it will affect all N plans – both new and old.

It’s worth noting that your office copay could be less than $20, but never more. It depends on the billing practices of your doctor’s office. Specialist visits are also $20 – they are not allowed to charge more. You should also know there is no unique copay for Urgent Care. It would be $20 as well.

If you visit several doctors on a monthly/regular basis, then Plan N may not offer significant savings over Plan G or Plan F. However, for most, this supplement can help to keep their monthly premiums lower.

It Does Not Cover The Small Medicare Part B Deductible

Like Plans G and D, Medicare supplement Plan N does not cover the Part B deductible. Of the two Medicare deductibles, it is the much smaller one. Part A is the big one. Part B applies to doctor visits and outpatient procedures. Part A occurrences are for hospital and inpatient procedures.

For 2025, the Part B deductible is $257. It was only $240 in 2024 and $226 in 2023. The increases are usually small. It was $233 in 2022, $203 in 2021, $198 in 2020, $185 in 2019, $183 in 2017-18, and $166 in 2016. As you can see, it does not move much. That’s because it’s tied to inflation. The increases are not arbitrarily set; rather they are tied to inflation metrics which usually move slowly.

If the Part B deductible increases significantly, you should know that Medicare supplements covering this gap will increase their premiums to account for the change. They will not absorb this cost. It will be passed on to you. One way or the other you are paying for it. At least with Plan N, you have some control over it.

And you may know that no new supplements can be sold after 2020 covering the Part B deductible. This ensures consumers have more skin in the game. This change made Plan N more attractive since it only competes with Plan G as a top comprehensive Supplement.

Plan N Does Not Cover Part B Excess Charges

You would only face Part B Excess Charges if you choose to see a doctor who does not accept Medicare Assignment. This could be a doctor who charges more than what is allowed by Medicare. The maximum Part B Excess amount is 15% above what Medicare deems normal and customary.

Plan N does not cover Part B excess charges, but these fees are rarely encountered. In a few states, like Ohio for example, Part B excess charges are not allowed. If you are considering Plan N in a state like Ohio, you don’t need to worry about Part B Excess Charges. Doctors cannot charge them even if they wanted to.

The other states where Part B Excess Charges are not allowed, include: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. (You can compare the list of what each supplement covers here.)

Most doctors won’t charge Part B Excess – even if they are in a state where they’re allowable. It would be hard for them to stay in business. Consumers would find another doctor. We have several Plan N clients at our independent insurance agency. No one has told us this gap is causing them financial distress. 

The Argument For Plan N Medicare Supplements

The argument for Plan N is a simple one:  You can lower your monthly premiums without adding significant out-of-pocket exposure.

The premiums you save in most cases can more than account for the gaps not covered by this supplement.

The copays are small and have not increased since Plan N was released in June 2010. It’s unlikely they ever will.

The Part B deductible is the smaller of the two Medicare deductibles (Part A deductible is much higher and covered by Plan N) and will not break the bank.

Part B Excess charges are rare, and if you encounter them, you can always change doctors  If you live in a state like Ohio, it’s a moot point – doctors are not allowed to charge Part B Excess amounts.

The Argument Against

This may be more of a “peace of mind” argument. Many of our clients want the best coverage money can buy. So they buy Plan F or Plan G. There is nothing wrong with that idea. We recommend drilling down a little further, however. Peace of mind today can lead to frustration tomorrow.

But in other cases, you may consult with several doctors on a regular basis. You may worry about the copays adding up over time. Or perhaps you have a favored doctor who doesn’t accept Medicare Assignment and you’re running into frequent Part B Excess charges.

These are valid arguments against a Part N plan. It has more gaps you will need to cover than Plan G. In cases like this, you may benefit more from a more comprehensive Supplement.

Contact Us To Learn More About Medicare Supplements

Hyers and Associates is an independent insurance agent specializing in Medicare supplements, Advantage Plans, and Prescription Part D drug coverage. We license directly with all carriers and can help you compare Medigap quotes from several insurance companies.

If you are considering Plan N Medicare Supplement insurance or any other Medigap plan, contact us today. We can help you compare rates, benefits, and out-of-pocket exposure so you can enroll in the plan that best fits your needs and budget.

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Category: Medicare Supplements

Last updated on February 17th, 2025