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What does Medigap plan N cover?
Medigap Plan N is a relatively new Medicare supplement plan that came into existence in 2010. It is now the 3rd most popular plan in Georgia behind plans F and G.
Medigap plan F is oversold for many reasons, not the least of which is the high premium and corresponding high commission. Many Medigap brokers take the easy way out and simply try to compete on price for plan F without ever explaining the value of plans G and N.
Simply stated, Medigap plan N covers 100% of your approved Medicare Part A hospital expenses in the same was as plans F and G. Approved Medicare Part B charges have cost sharing under plan N.
When you have the N plan you are responsible for office visit copay’s up to $20, ER copay’s up to $50 and any excess charges incurred when you use a provider that does not take Medicare assignment.
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Does Medigap plan N include out of country coverage?
Only Medicare supplement plans F and G include some coverage when you travel outside the United States.
For the most part, original Medicare does not cover out of country charges. Exceptions would be if you had a medical emergency while in a neighboring country like Canada or Mexico and it was not reasonable to travel to the U.S. for treatment.
Medigap plans C, D, F, G and N will pay 80% of emergency medical expenses after a $250 deductible. Refer to Medicare publication 11037 for more details.
Anytime you travel out of the country you should always consider purchasing a travel medical plan as offered by HCC.
What are Medicare excess charges?
Excess charges occur when a Medicare beneficiary uses a provider that does not accept Medicare assignment. Since 96% of providers DO accept assignment it is not an issue that will come up with any frequency.
If you do decide to use a provider that does not take assignment, be aware when you have Medigap plan N you are responsible for any balance billing by the provider once Medicare has approved your claim.
Excess charges are capped by Medicare. The calculation works like this.
If the Medicare approved amount for a Part B expense is $100 (and you have satisfied your Part B annual deductible), Medicare will pay you 80% of 95% of the Medicare approved claim. The claim is initially reduced by 5% for a non-par provider which means the MAC (Medicare approved claim) is now $95. Medicare pays you 80% of $95 or $76.
Your Medigap plan N will pay you 20% of the 95% or $19.
Your doctor is allowed to bill you 15% in excess of the $95 MAC.
At this point you have received $76 from Medicare, $19 from your Medigap plan N carrier. The claim is capped at $109.25 which is referred to as the limiting charge.
In this case you will owe the doctor $14.25 out of your pocket.
Your doctor is required to submit your bill to Medicare and must wait until Medicare has adjudicated the claim and you have received payment from Medicare and your supplement carrier before they can bill you.
Why pick Medicare supplement plan N?
For many people it is a cost effective alternative to most Medicare Advantage plans. Medicare Advantage plans have doctor and hospital networks that may be inconvenient for you, the patient. The cost sharing under Medicare Advantage plans can be significant, as much as $6700 in 2018 and that is just for IN network approved charges. Your out of network charges are in addition and may not be capped at all.
It is rare for a Medicare beneficiary with plan N to have out of pocket expenses that exceed $500 per year and with most people your out of pocket is considerably less.
Medigap plan N offers more value than plans F or G for most people but it is not for everyone. If you have a chronic condition that requires multiple doctor visits over the course of a year, plan N may not be the best plan for you.
I turned 65 in September of 2015 and chose Medicare supplement plan N for myself. Next April when my wife goes on Medicare she will probably pick the same plan.
How much can you save with plan N?
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