What Is Medigap Plan N? What You Need to Know

Medigap Plan N is a Medicare Supplement Insurance plan that helps pay for out-of-pocket costs that Medicare Part A and Part B, also known as Original Medicare, don’t cover.

If you expect to have relatively infrequent medical appointments, Medigap Plan N may be a more cost-effective option compared with other Medigap plans. This is because it has higher copays, but lower monthly premiums.

» MORE: Best Medicare Supplement Insurance companies

How it works

Once Medicare pays its approved amount for health care costs and services, Medigap Plan N will supplement “gaps” left in your coverage. For example, Plan N can cover your Medicare Part A deductible or 100% of the Part B coinsurance, except for copayment for some doctors’ office visits and/or certain emergency room visits..

Medigap Plan N keeps its premiums low by offering reduced coverage for certain benefits. Rather than covering your entire Part B copayment, Plan N requires you to pay these copays:

• Office visits: up to $20 for some office visits.

• Emergency room visits: up to $50 if you're not admitted to hospital inpatient care.

After that, Plan N covers anything of your Part B copay or coinsurance that's left.

» MORE: Medigap Plan G vs. Plan N

Medigap plans are only available if you have Original Medicare — they can’t be used with Medicare Advantage plans.

There are 10 standardized Medigap plans available in most states (except Massachusetts, Minnesota and Wisconsin, which use different standards). The plans differ in terms of coverage for services, out-of-pocket limits and premium costs.

What Medigap Plan N covers

Here’s what Plan N covers, according to Medicare.gov:

• Part A coinsurance and hospital stays up to an additional 365 days after Medicare benefits are used up.

• Part A deductible.

• Part A hospice care coinsurance or copayment.

• Part B coinsurance (copayments are up to $20 per office visit and up to $50 per emergency room visit; waived if admitted).

• Skilled nursing facility care coinsurance.

• Blood transfusion (first three pints).

• Medically necessary emergency health care service for the first 60 days when traveling outside the U.S. Deductible and limitations apply.

What Medigap Plan N doesn’t cover

Medigap Plan N is one of the more comprehensive Medicare Supplement Insurance plans. However, there's one benefit included in some other plans that Plan N doesn’t cover — Medicare Part B excess charges (if a provider is permitted to charge more than Medicare’s approved amount and does so).

Additionally, all Medigap plans, including Plan N, sold to new Medicare members don’t cover the following:

• Part B deductible. (Since 2020, new Medicare members can’t buy any plan that covers the Part B deductible, although existing members may own older plans that do.)

• Prescription drugs.

• Long-term care (like non-skilled care you get in a nursing home).

• Dental care.

• Vision care.

• Private-duty nursing.

How much does Medigap Plan N cost?

Medigap plans are regulated by the government but sold by private health insurance companies. The cost of a Medigap Plan N policy varies based on factors including age, location and tobacco use. In a representative North Carolina ZIP code (27406), monthly Plan N premiums for a 65-year-old nonsmoker range from $66 to $310.

» MORE: How much does a Medicare Supplement Insurance plan cost?

To get the best price for your Plan N coverage, you should enroll in Medigap as soon as you’re eligible — when you turn 65 and you’re enrolled in Medicare Part B.

Policies are much cheaper during this six-month Medigap open enrollment period because companies aren't allowed to consider your current health or medical history when writing the initial policy. They do, however, take health conditions into account after this enrollment period, which can result in you paying more for the same coverage or being denied entirely.

In some states, insurance companies sell Medigap plans to those under 65 who are living with a disability and are eligible for Medicare. You can find more information at your local State Health Insurance Assistance Program, or SHIP.

When shopping for a Medigap plan, review your medical records. If you don’t frequently visit the doctor, then Plan N may be the better option for you.

Visit Medicare.gov and enter your ZIP code to find a plan that best works for you.

If you have questions about Medicare, visit Medicare.gov or call 800-633-4227 (TTY: 877-486-2048).

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