Medigap Plan N Copays

Medigap Plan N has copays with some of it’s Medicare Part B benefits. For doctor visits, in office, you have a $20 copay per visit. There is also a $50 copay for emergency room services, provided you are not admitted to the hospital. If you’re admitted, the $50 copay is waived. The copays apply after you have paid your annual Part B Deductible. In 2016, the deductible is $166.

Medigap Plan M Cost-Sharing

Medigap Plan M requires a cost-sharing of 50% for the Medicare Part A Deductible. In 2016, the deductible is $1,288. You would owe $644 for each qualifying benefit period. A Benefit Period begins the first day you enter the hospital and ends after leaving and going 60 consecutive days without being re-admitted. After the 60 days, you would owe another $644 if you are admitted to the hospital again that calendar year.

Medicare Supplement Benefits That Both Plans Cover

Except for the differences in cost sharing and copays, Medigap Plan M and Medigap Plan N offer the same Medicare Supplement benefits.

Covered Benefits:

• Medicare Part A Coinsurance (Hospital)*
• Medicare Part B Coinsurance (Medical)**
• Blood (First 3 Pints)
• Part A Hospice Care Coinsurance and Copay
• Skilled Nursing Facility Care Coinsurance
• Part A Deductible
• Foreign Travel Emergency

* Medigap Plan M cost-sharing
** Medigap Plan N copays

Medicare Supplement Benefits That Both Plans Do NOT Cover

Both plans don’t offer coverage for the same two Medicare Supplement Benefits.

Benefits Not Covered:

• Part B Deductible
• Part B Excess Charges

Not having coverage for both of these benefits should not be a concern. The Medicare Part B Deductible is a once a year deductible that is $166 in 2016. To have coverage for the benefit will cost you more than the $166. As for Part B Excess Charges, they are also no concern. For more details, see my post “The Truth About Part B Excess Charges.”

And the Medigap Plan Winner Is

Of course, like always, it comes down to price. However, there would have to be substantial premium savings with a Medigap Plan M over a Medigap Plan N for the Plan M to make sense. The only difference between the two is the cost-sharing and copays. The cost of one hospital admittance with a Plan M equates to thirty-two doctor visits with a Plan N ($644 part A deductible cost divide by $20 office visit copay). Still, in most areas, you will find Medigap Plan M priced higher due to first dollar coverage (after deductible), for Part B benefits. With first dollar coverage, people tend to see the doctor for every cough and sniffle, which is very costly for insurance companies.