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Plan F vs. Plan N : What Most People Don’t Know

Plan F vs Plan NPlan F vs Plan NA lot of folks wonder about the differences between Medicare supplement Plan F and Plan N:

  •  What does plan F cover vs. plan N?
  • Which one is the more popular Medicare supplement plan ?
  • Does Medigap Plan N cost less?

These are all good questions which deserve a good answer.

We will answer these questions…and more by exploring all you need to know about Plan F vs. plan N

Before we compare Medicare supplement plans,  we need to review a little about Medicare:

Medicare is a federal health insurance program that pays most of the health care costs for people who are 65 or older.  It will also pay for health care for some people under age 65 who have disabilities.

Original Medicare has two parts, A and B. Part A covers Inpatient care in hospitals, skilled nursing facility care, some home care, and hospice care. Part B covers doctor services, outpatient care, some home care, durable medical equipment and some preventive services. Not all costs are covered, though.

You will usually be responsible for copays, coinsurance and deductibles (your out-of-pocket expenses).

How do Medicare Supplement Plans Work?

A Medicare Supplement policy (or plan) is private insurance that helps pay for those out-of-pocket expenses.

It is one of two options available to you to pay for some or all of these costs. The other option is called Medicare Advantage (Medicare Part C)

There are ten standardized Medigap plans.

They are denoted by the letters A through N. Because these plans are offered by private insurance companies, the cost and availability of each lettered plan may differ, but not the benefits.  In other words, all companies that offer, say Plan F, must offer the same standardized benefits for their Plan F.

The chart below shows basic information about the different benefits that the 10 Medigap (Medicare supplement) policies cover. If a check mark appears, the plan covers the described benefit 100%. If a percentage appears, the plan covers that percentage of the benefit:

Medicare Supplement Chart

With a Medicare supplement policy (“Medigap”) you can go to any doctor, anywhere in the United States, as long as that doctor accepts Medicare. The companies that offer these policies are allowed to charge whatever they want for the coverage.  So premiums will vary among companies.  They are also allowed to determine their own underwriting criteria for enrollment.

You should know, though, that all companies must enroll you on a guaranteed basis, also known as Medicare Supplement Open Enrollment,  when you turn 65.

 

Plan F vs. Plan N Benefits

Ok, now that you have the basics, its time to get more specific with these two plans.

Plan F

Again referring to the chart, you can see that all the Medicare benefits boxes are checked for Plan F. That means that when Medicare approves a medical expense, Plan F covers 100% of your out-of-pocket expenses (copayments, coinsurance and deductibles).

Plan F also covers 80% of foreign travel emergency expenses with a $250 deductible and $50,000 lifetime maximum.

Plan N

The chart shows that Plan N covers as much as Plan F covers except for:

  • The Medicare Part B deductible
  • Medicare Part B excess charges
  • Doctor Visit and Emergency Room Copays

Part B deductible

The Part B deductible for 2017 is $183. You are responsible for this yearly amount whenever you begin to receive any Part B services with Plan N.

Part B Excess Charges

When you compare Medicare supplement plans, it is essential that you understand Part B excess charges.

Many people, and many insurance agents for that matter, struggle to understand what a Medicare Part B Excess charge is.

Simply put , it is an additional amount that a physician or other healthcare provider can charge you over and above the Medicare approved amount.

There are many doctors and facilities who accept the Medicare allowed charge.  However, there are also doctors and other healthcare providers who DO NOT accept the allowed charge and have excess or additional charges.

Here is an example that will make it clearer:

Let’s say Ellen is visiting a new physician for an office visit and has Original Medicare Part A and Part B, but no other insurance or plan.  Medicare’s allowed charge for her visit is, say, $100.  The physician has the option and a right to charge up to 15% over the Medicare approved amount.

Ellen’s physician doesn’t accept the Medicare allowed payment and charges the additional 15 percent or, in this case, $15.00.  The allowed charge is $100 and Medicare will pay 80%, which means Medicare will pay the physician $80.00.  You are responsible for the 20% ($20 in this case)  and the 15% ($15 in this case) excess charges or making your out-of- pocket cost $35.

Remember, if a doctor or other healthcare provider does not accept Medicare assignment, they can charge you, the patient, for the co-insurance plus an additional 15% of the total allowed charge. There are a few states, though, that do not allow medical service providers to charge for these Part B excess charges. They are  Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. 

Doctor Visit and Emergency Room Copays

Under a Plan N, you may also have to pay up to $20 copay per office visit, and a $50 copay per emergency room visit.  The $50 is waived if you are admitted to any hospital, and the emergency room visit is covered as a Medicare Part A expense.

 

The main point for you here is that if your doctor or other healthcare providers accept Medicare assignment, you will not be paying for Part B excess charges… …and if you were enrolled in a plan N, your out-of-pocket costs would be the same as Plan F, except for  having to pay the annual $183 Part B deductible, and doctor visit and emergency room copays.

If the cost of a Plan N was substantially lower than the cost of a Plan F, perhaps a plan N would make a lot of sense for a lot of people.

Let’s take a look at those costs by showing a Medicare supplement Plan F rate comparison with that of Plan N.

Plan F vs. Plan N Cost

Below you will see two charts with Plan F and Plan N rates. The first one shows the monthly premium at age 65 for 5 of the top insurance companies that offer a Medicare supplement plan, and the second shows those rates for someone age 70. These rates are for the San Francisco area:

Plan F and N Premium 65

 

Planf and N Premuim 70

 Among these 5 companies,

the average cost savings between plan F and Plan N for someone age 65 is $48.69 per month or $584.28 per year.

For someone age 70 those cost savings are a little higher; $58.59 per month or $703.14 per year.

So, if your doctors and other healthcare providers accept Medicare assignment, and you are age 65 and choose Plan N, your cost savings per year would be about $584.28, minus $183 (your Part B deductible which you must still pay),  office visit copays and perhaps emergency room copays.

Keep in mind that these savings will occur if all health care providers accept Medicare assignment.

But also keep in mind, that even if some of those health care providers do not accept assignment and charge the allowed 15% extra, your savings may still be significant.

We are left with these conclusions:

  • Both Plan F and Plan N are popular, comprehensive plans.
  • Plan N benefits are almost the same as Plan F benefits.
  • Plan N can be significantly less expensive than Plan F, without giving up, in many cases, a lot of benefits.
  • You will need to do some homework to determine which plan is better for you,  or if you should buy a supplement plan at all.

A professional, experienced agent can help make this homework and the process to compare Medicare supplement plans so much simpler and easier.

You can reach us at 415-999-5071 or jdaura@clearmedicaresolutions.com

 

 

 

 

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