Gap Insurance Plan N

Medigap Plan N

Medicare Supplement Plan N, also known Medigap Plan N is the third most popular Supplemental Insurance Plan. Plan N is considered a cost-sharing option due to the required copays for certain services. It has a $20 copay for doctor visits and a $50 copay for emergency room visits (if you are not admitted). There are Nine covered benefits offered through Standardized Medicare Supplement Plans. Medigap Plan N covers seven of them.

Medigap Plan N Costs and Rate Increases

Since Medigap Plan N was just released in 2010, historical data on rate increases is limited. However, it is currently trending lower than the two other most popular plans, Medigap F and G. Because Supplemental N does not have first-dollar coverage, along with copays for doctors visits and emergency room services, rate increases should be much lower over time.

Lower Utilization Equals Lower Rate Increases

Medigap Plan N does not cover the Medicare Part B Deductible. It also has copays. Because insureds will have an out-of-pocket expense for doctor and emergency room visits, they are less likely to seek treatment for minor injuries and illnesses. To the insurance company, this means less claims. To the insured, this means less rate increases.

Medigap Plan N Copays

Here is a list of the copays associated with an N Plan and the amounts for 2016.

A $20 copay for most doctor visits
A $50 copay for emergency room visits when patient is not admitted

What Does a Medigap Plan N Cover

First introduced in 2010, Medigap Plan N covers seven of the standardized Medicare Supplement benefits. Here’s a list of 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

What Does a Medigap Plan N Does Not Cover

Part B Deductible
Part B Excess Charges

Medigap Plan N and Your Covered Medicare Part A Costs (Hospital) Per *Benefit Period

The following chart shows your coverage under Medicare Part A, along with your gap coverage with a Medicare Supplement Plan N and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.

Hospitalization

This includes semi-private room and board, general nursing, and miscellaneous services and supplies.

	Medicare Pays	Medigap Plan N Pays	You Pay
First 60 days	All but $1,288	$1,288 Deductible	$0
61st through 90th day	All but $322 a Day	$322 a Day	$0
During your 60 lifetime reserve days	All but $644 a Day	$644 a Day	$0
Once lifetime reserve days are used, during your additional 365 days	$0	100% of Approved Expenses	$0
Beyond the additional 365 days	$0	$0	All Costs

Skilled Nursing Care

You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days of leaving the hospital.

	Medicare Pays	Medigap Plan N Pays	You Pay
First 20 days	All Approved Amounts	$0	$0
21st Through 100th day	All but $161 a Day	Up to $161 a Day	$0
101st Day and after	$0	$0	All Costs

Blood

	Medicare Pays	Medigap Plan N Pays	You Pay
First Three Pints	$0	100%	$0
Additional Amounts	100%	$0	$0

Hospice Care

You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

	Medicare Pays	Medigap Plan N Pays	You Pay
Hospice Care	All but very limited coinsurance for outpatient drugs and inpatient respite care.	100%	$0

* A benefit period begins when you receive services as an inpatient in a hospital. It ends after you have been out of the hospital and have not received skilled care in another facility for 60 consecutive days. All Part A copayments and deductibles start new with the beginning of each new benefit period.

Medigap Plan N and Your Covered Medicare Part B Costs (Medical)

The following chart shows your coverage under Medicare Part B, along with your gap coverage with a Medicare Supplement Plan N and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.

Medical Expenses in the Hospital or While Receiving Outpatient Treatment

This includes physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment.

	Medicare Pays	Medigap Plan N Pays	You Pay
First $166 of Approved Amounts	$0	100%	$166 Part B Deductible
Remainder of Approved Amounts	80%	20%	$20 Per Doctor’s Office Visit
Part B Excess Charges	$0	$0	All Costs

Blood

	Medicare Pays	Medigap Plan N Pays	You Pay
First Three Pints	$0	100%	$0
Next $166 of Approved Amounts	$0	$0	$166 Part B Deductible
Remainder of Approved Amounts	80%	20%	$0

Clinical Laboratory Services – Tests for Diagnostic Services

	Medicare Pays	Medigap Plan N Pays	You Pay
Lab Services and Tests	100%	$0	$0

Medigap Plan N and Your Covered Costs for Approved Home Health Care Service Under Both Medicare Part A and B

The following chart shows your coverage under Medicare Part A and Part B, along with your gap coverage with a Medicare Supplement Plan N and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.

Medicare Approved Home Health Care Services

	Medicare Pays	Medigap Plan N Pays	You Pay
Medically Necessary skilled care services and medical supplies	100%	$0	$0
Durable Medical Equipment First $166	$0	$0	$166 Part B Deductible
Remainder of Approved Amounts	80%	20%	$0

Medigap Plan N Benefit Comparison

Medigap Plan N Benefit Chart

*Plans K-N provide for different cost sharing.

*Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% for Plan K, and 75% for Plan L. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The annual out-of-pocket limit does NOT include costs from your provider that exceed Medicare-approved amounts (excess charges).

*Plan F is also offered as a high-deductible plan. With a high-deductible Plan F, you must pay for Medicare-covered expenses such as copays and deductibles up to $2,180 in 2016 before the policy pays anything.

*Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits.