Medigap Plan N Details
Find out how Medigap Plan N works and what it covers
by Senior 65+ on
Oct 22, 2015
| 5 Comments
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Medigap Plan N Overview
Medigap Plan N is a Medicare Supplement plan that fills in some of the “gaps” of Original Medicare. While, Medigap Plan N covers many of the offered benefits of Medicare Supplement, it can offer a lower monthly premium than some other plans, because with Plan N you can pay copays, your Part B deductible, and excess charges.
Remember Medicare Plan N plans are designed to complement Original Medicare Part A and Part B. Below is a list of what you would pay under Original Medicare alone, and then what you would pay if you enroll in Medigap Plan N.
Medigap Plan N Benefit Details
| Benefits | Original Medicare Alone | Original Medicare With Medigap Plan N |
| Doctor Network | All Doctors that accept Medicare | All Doctors that accept Medicare |
| Part A Hospital Benefit Period Deductible | You pay $1,364* | You pay $0 |
| Hospital days 61-90 | You pay $335 per day per day | You pay $0 |
| Hospital Days 91-150 | You pay $670 per day per day (lifetime reserve days) | You pay $0 |
| Beyond Lifetime Reserve Days | You pay 100% | You pay $0 up to an additional 365 hospitalization days. |
| Skilled Nursing Facility Care Days 1-20 | You pay $0 (Part A deductible applies)** | You pay $0 |
| Skilled Nursing Facility Care Days 21-100 | You pay $167.50 per day | You pay $0 |
| Hospice Respite Care | You pay 5% | You pay $0 |
| First 3 Pints of Blood | You pay 100% | You pay $0 |
| Additional Blood | You pay $0 | You pay $0 |
| Part B Annual Deductible | You pay $185 | You pay $185 |
| Ambulance | You pay 20% (Part B deductible applies) | You pay $0 after Part B deductible |
| Doctor’s Office Copays/Coinsurance | You pay 20% (Part B deductible applies) | You can pay up to $20 for some office visits (Part B deductible applies) |
| Durable Medical Equipment | You pay 20% (Part B deductible applies) | You pay $0 after deductible |
| Part B Excess Charges | You pay 100% (Part B deductible applies) | You pay 100% (Part B deductible applies) |
| Foreign Travel Emergency | You pay 100% | You pay 20%*** |
| Out-Patient Surgery | You pay 20% (Part B deductible applies) | You pay $0 after Part B deductible |
| Urgent Care | You pay 20% (Part B deductible applies) | You pay $0 after Part B deductible |
Next Steps for Medigap Plan N
Get quote: Click here to see prices for Plan N
Learn more about Medigap Plan N
The fine print of the Medigap Plan N Chart Above
*Medicare Part A deductible is broken down into 60 day benefit periods. You have to pay the deductible if you reenter the hospital after 60 days from discharge. Example: If you enter the hospital March 1st you’ll pay the Part A deductible. If you leave the hospital 5 days later and return to the hospital on July 6th, you will be charged the Part A hospitalization benefit again.
**For Skilled Nursing you must have a 3-day qualifying stay in the hospital to qualify for Skilled Nursing Facility care AND you’ll still pay the benefit period Part A deductible ($1,364).
***Foreign Travel Emergency requires a deductible of $250. You will have to have your emergency within the first 60 days of travel, and the plan has a lifetime coverage amount of $50,000.
Reader Comments and Questions
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By Oscar on November 22, 2018
Good morning.! Why there is so much difference in prize on medigap plan G medical insurance Companies? Thank you. Oscar
-Chris from Senior65.com
By Judy on November 28, 2016
In New York, the excess charges are limited to 5%. Also, in NY, you are not subject to underwriting if you change plans as long as you have "continuous coverage." The copay for plan N says, "up to $20." I have been told that it depends on the reason for the visit and what code is used by the doctor when the claim is submitted. Here's my question: What would be the copay for physical therapy, mental health counseling, and any other long-term therapy? This is where it can add up. If going for physical therapy 3 times a week with a $20 copay per session, that would be $60 per week and approximately $240 per month. Just wondering if you can offer any specifics with regard to this.
Yes, it is true about guaranteed issue plans for NY, but it is not true that there is a 5% limit -as New York has instituted the MOM Law (Medicare Overcharge Measure) with does not allow for any excess charges.
To get to your question, yes, you could be charged a copay every time you see any doctor or physical therapist.
If you need help finding a Medigap plan in your area, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/
By Kim Boyd on July 12, 2016
Do you have to pay the office visit co-pays until you meet your deductible on plan G? That would be an awful lot of office visits if that is the case.
You are correct! With Medigap Plan G, you will have to pay 100% toward your Part B costs, until you meet your Part B deductible. This means that you would pay the full cost of doctor's office visit -which is generally quite a bit higher than a copay, your durable medical equipment, drugs administered by your doctor, and any other service covered under Part B. However, the deductible isn't very high, and you should meet that rather quickly. If you need help finding a Plan G plan, please call one of our licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/
By Debbie on February 23, 2016
I am still confused by the term "excess charges" with Plan N. Are these excess charges only up to the Part B $166. deductible or in excess of It? If so, then please help me understand what these excess charges would be capped at? Thank you!
Excess charges are charged by providers who do not accept Medicare-assignment. While you will still owe your Part B deductible, your Part B deductible and excess charges do not have any other direct correlation, and there is no cap on how much you can spend on excess charges. To limit your out of pocket costs, consider that only Medigap G and F cover excess charges.
-Amy from https://www.senior65.com/
By Lee on October 29, 2015
Can you please tell me the major differences between plans G and N? Do they both go through underwriting? As for plan N not covering ‘excess charges,’ do excess charges usually amount to a lot, I have no idea. And on the comparison chart, co-pay amounts aren’t listed; do all medigap plans have co-pays for office visits? On top of all that, do most medigap plans not have a max. out of pocket per year? Lots of questions I know… if you answer these, thank you!
Thank you for your questions.
1) The major difference between G and N are: G covers your excess charges and you are not charged copays. Whereas, Medigap Plan N charges you $20 copays for doctors visits and $50 emergency room copays, and doesn't cover your excess charges
2) If you enroll when you're first eligible for Medigap, you will not have to go through underwriting. However, Medigap G and N are not guaranteed issuance at any other time and you will have to answer medical questions (such as first enrolling in Part B after 65 and leaving your job-based insurance)
3) Excess charges could add up, as it is up to 15% over what Medicare covers.
4) Medigap Plans K and L require that you pay a percentage of your copays and coinsurance, but only N has that separate copay.
5) Medigap Plans L and K put a cap on what you can spend based on the percentage you pay out. But the rest of the plans do not have caps -because the majority of the plans limit your liability and a cap would be redundant.
Hope this helps!
-Amy from https://www.senior65.com/