Choosing the right Medicare Supplement Insurance (Medigap) plan is a critical decision for seniors looking to fill the coverage gaps left by Original Medicare. Among the available Medigap plans, Plan G and Plan N stand out for their extensive benefits. However, selecting between these two options can be confusing. To help you make an informed choice, we’ll break down the main differences between Medigap Plan G and Plan N, focusing on coverage, cost, and other considerations.
Coverage Differences
Both Plan G and Plan N offer robust protection beyond Original Medicare, covering essential expenses such as Part A coinsurance, hospital costs after Medicare benefits are used up, hospice care coinsurance, and more. However, there are notable differences in the coverage provided by each plan:
- Plan G is designed for those seeking comprehensive coverage. It includes all the benefits of Plan N, with the addition of covering Medicare Part B excess charges. These excess charges occur if a provider does not accept Medicare assignment.
- Plan N offers slightly less coverage in exchange for generally lower premiums. It does not cover Part B excess charges and involves a $20.00 copay for certain office visits and a $50.00 copay for emergency department usage.
Understanding Part B Excess Charges and Copays
Part B Excess Charges:
Some providers who don’t accept Medicare assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called “non-participating.”
If your doctor, provider, or supplier doesn’t accept assignment:
- You might have to pay the full amount at the time of service.
- They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare.
- They can charge up to 15% over the Medicare-approved amount for a service, but no more than that. This is called “the limiting charge.” Most health care providers have agreements with Medicare to accept the approved amount, so excess charges are not common.
- Copays with Plan N: If you opt for Plan N, be prepared for copayments for some doctor’s office visits and emergency room trips. These copays are typically modest but can add up over time depending on the frequency of your healthcare visits.
When it comes to cost:
- Plan N is appealing for its lower premium rates compared to Plan G. This can make Plan N an attractive option for those who are relatively healthy and infrequently visit the doctor.
- Plan G, while typically more expensive in terms of monthly premiums, could save you money in the long run if you require extensive provider visits.
Making Your Choice
Deciding between Medigap Plan G and Plan N comes down to your healthcare needs, your financial situation, and your preferences regarding copays and premiums. Here are a few questions to consider:
- How frequently do you visit healthcare providers?
- Are your preferred providers more likely to charge Medicare Part B excess charges?
- Would you prefer to pay no copays and potentially higher premiums with Plan G, or lower premiums with some copays under Plan N?
Remember, the best choice is personal and depends on your specific situation. Whether you prioritize the comprehensive coverage of Plan G or the lower premiums and copay model of Plan N, both plans offer valuable benefits worth considering.
Once you’ve evaluated your needs, talking to a Medicare advisor can help clarify any uncertainties and guide you toward the plan that best fits your unique health care goals and financial situation. Making the right Medigap choice will ensure you are well-protected and can enjoy your golden years with peace of mind.