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($198 for 2020). Medicare increases this deductible a few dollars 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.
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” for purposes of determining whether the subscriber is subject to the Plan N Part B coinsurance or co-payment of up to $20. 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.