The Lowdown On Plan N

Plan N is currently one of 10 standardized Medicare Supplement Plans designed by Medicare to help fill the gaps in Medicare Part A and B. This plan presents a good value as it offers comprehensive benefits at more affordable premiums than some of the other popular plans. There are some important things you should know about plan N that can be hard to understand if you are just looking at the chart in the Medicare Guidebook.

With Medicare Part A, Part B and a Medicare Supplement Plan N you are covered 100% for all Medicare-approved inpatient hospital expenses.

For medical expenses under Part B Medicare with Plan N, you are responsible to pay the annual Medicare Part B deductible($226 for 2023). Medicare increases this deductible a every year. Under plan N, you are also responsible for a co-payment for doctor’s office visits that cannot exceed $20. This can be confusing as it is stated in the Medicare & You Guidebook that the co-payment is “up to” $20.

 
How does this work exactly?  

The deductible must be met before the co-payments begin. This means you will not have to pay a co-payment for doctor’s office visits until you have satisfied the deductible.

Under Plan N, what constitutes an “office visit”. For purposes of determining whether the subscriber is subject to the Part B coinsurance or co-payment of up to $20? Services coded as office visits or evaluation and management visits and billed on Part B professional claim forms would be considered “office visits”. The co-payment is only applied to office visits and not to other charges such as laboratory, x-ray or durable medical equipment. Co-payments do not apply to Urgent Care visits.

What does “up to” mean? The co-payment is the lessor of $20 or the Medicare Part B coinsurance, which is 20%. This means if the 20% of the Medicare-approved amount is less than $20 you will pay the lessor amount, but if it’s more you will never pay more than $20.

There is an up to $50 co-payment for emergency room visits that do not result in an inpatient hospital stay. The “lesser rule” applies to this co-payment as well.

What are Excess Charges?

Plan N will not cover excess charges. Excess charges only apply to doctors that do not accept assignment of Medicare. Medicare allows these doctors to charge up to 15% above the Medicare-approved amount. Excess charges are rare, as most doctors in the United States accept Medicare assignment. None of my clients have ever used doctors that do not accept assignment. If your doctor does not accept assignment you may have to pay the bill up front and wait to be reimbursed Medicare’s approved amount. Or, you could simply go to a very good doctor that accepts assignment and not have to hassle with reimbursement from Medicare. Even if you have a Plan G, you still have to wait to be reimbursed from Medicare by filing the claim yourself. 

 

In Summary

For most people Plan N is an good choice. The premiums are much lower and the out of pocket expenses are low. Plan N, is still experiencing lower percentage rate increases than Plan G and Plan F. This is important to consider as premiums increase each year on medigap policies. Also, find good doctors that accept Medicare, they are everywhere.
 
Thank you for reading and if you have any questions or want additional information please contact me.
 
Bill Clark
Owner/Licensed Agent
Seniors Choice
1-800-230-3211

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