Medigap Plan N – Advantage Plan Alternative
Medicare modernization act brings about new additions to standardized Medigap options
If you signed up for the free mini-course offered on the web form to the right and read the daily lessons, you know the difference between a Medicare Advantage Plan and a Medigap insurance policy (aka: Medicare Supplement).
This article is going to look at one new plan in particular; Medigap Plan N.
A brief overview
Most people know Medigap by its more common name, Medicare supplement insurance. A Medicare supplement is not an Advantage plan. A supplement is offered by a private insurance company to fill the gaps that original Medicare Parts A and B leave for the beneficiary. Normally this would be the hospital deductible and the 20% coinsurance for outpatient services.
You must maintain your Parts A and B (and pay the Part B premium) while paying the insurance carrier a premium for your supplement. An Advantage Plan, on the other hand, is when a private insurance company contracts with the government to administer your Medicare Plan. You still maintain Parts A and B and pay the Part B premium when you elect an Advantage Plan.
Originally, the benefit with an Advantage Plan was that you avoided the high monthly premium of a Medicare supplement. You also had some affordable cost sharing in the form of deductibles, coinsurance and co-pays with an Advantage Plan. Or, if there was a premium, in many cases it was considerably smaller that a premium for a supplement.
Reasons to consider Medigap Plan N
Here are some good reasons to consider Medigap Plan N. Keep in mind that everyone has different needs and not all features will appeal to everyone.
- No network restrictions. Use any provider that accepts Medicare.
- Plan design allows premiums to be lower than many Advantage Plans.
- No out of pocket costs for hospital stays. Part A deductible is paid by the plan ($1132 for 2011).
- Foreign travel covered in emergency situations.
- Skilled nursing facility coinsurance covered.
- Includes 100% Part B coinsurance (no 20% responsibility), except up to a $20 co-payment for office visit and up to $50 co-payment for ER.
- Generally no underwriting except for renal disease question.
- Premiums lower than most other standardized plans and often lower than an Advantage plan.
- No restrictive enrollment periods.
This plan is almost a hybrid. You have the benefits of a supplement and the convenience of an Advantage Plan. The co-pays for office visit and ER are a small price to pay for a substantially reduced premium.
What’s the catch?
If you are looking for a zero dollar Advantage plan, this is not it. But in the long run, you may pay less with Medigap Plan N than an Advantage Plan. Just the fact that you will not pay a deductible or a copay, for a limited number of days, if you are hospitalized is huge! Not to mention that many Advantage Plans now offer the same benefit for outpatient surgery and durable medical equipment as original Medicare. That is, they pay 80% and you pay 20%. Think about it. You have an Advantage Plan with little or no premium but you have to pay 20% for outpatient surgery. You may reach your maximum amount out of pocket quickly (which will most likely be more than the annual premium for Medigap Plan N.
The second thing to consider is that Medigap Plan N, like all Medicare supplements, will not include prescription drug coverage. You will need to purchase a stand alone Part D plan. I encourage you to explore your options to determine if a Medigap Plan N is right for you. This plan option becomes available starting with June 2010 effective dates.
To learn more about your plan options, you can visit the Medicare website or speak with a local agent who specializes in Medicare insurance plan options.
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Comments
Mark, I certainly understand how you feel, times are tight. But, even if you maintain only Medicare and do not opt for an Advantage plan or the Medigap plan N referenced in this post, you should only have your Part B premium of $96.40 per month that is deducted from your Social Security check.
Even with the high risk pool concept created by the Health care reform legislation, you could not touch a health insurance policy for $96.40 per month.
Because you are not 65, a medigap policy, if available in your state, would be more expensive that if you were 65. You may want to consider a Medicare Advantage plan. If you have it available, I would look at AARP Medicare Complete before I would throw in the towel for a $96.40 monthly Part B premium. AARP Medicare Complete typically has no monthly premium and may help with your medical expenses.
Hi Mark,
Sorry to hear about your disability.
So you want to leave Medicare? And so you will do what for health coverage? Go hang out at the ER like all the illegals do?
Here in Florida, there is a program where folks like you on a very limited income can get FLORIDA MEDICAID to pay your Part B premium. It is a simple application and IT WORKS!
I understand the 96.40 is a lot of money but there is help available.
Like David said, a Medicare Advantage Plan IS available to people under 65 and on Medicare.
Good luck.
I have been checking on medicare supplemental plans and they are very expensive..at least one of the most popular ones here are.. I want I checked in to several ins companys and AARP was one of the worse ones here .. Several of them want me to pay $350.00 a month and that is without a Plan D… which is another 100.00 a month or so ..
I think that just becaue i am not over 65 where my ins would be cheaper . The medicare advantage plans in my local area are now going to be PPO and HMO which is very high for my age group..It seems that your damned if you do or damnd if you dont..
I am like Mark I am under 64 and only fit into the 50-64 catagory. I am on disability also and I have done my budget and even with medicare still taking out the $96.40 (some people pay more depending on income) This is just to expensive .. I guess I am to either pay for ins (high) and drugs (high) and not pay my bills you know like rent food etc..
As for the info that George gave us for Florida. North Carolina has MEDICAD also which it offers to very very poor individuals.. and I dont quilify for that or for section 8 or food stamps or really any of the plans for lower income people ( Just thought I would throw that in) I think that just becaue i am not over 65 where my ins would be cheaper and medicare advantage plans in my local area are now going to be PPO and HMO which is very high for my age group..It seems that people over 65 are going to die before those of us with medical problems so our ins had to be more.. somehow on many areas that is just not right..
It seems that your damned if you do or damnd if you dont.. As for the ER (if I cant find a plan I can afford then I will have to go back to reg medicare and a stand alone drug…) No I will not give up medicare .. as for my ER visits they will still file medicare for it but dont know how they will recoup what I cant pay..They write off other people bills so I guess they can write off the part my ins does not pay for .
This is America and we are Americans and the way I look at it if illegals as you say can get help there then I certinely quilify for that…and at some point in the past I worded before disability so I paid into the system. The medicare part A is required (I think).Part B you might be able to drop.. not sure on that one.. FYI: Even if you keep the medicare and the 96.40 pays for it you have to have a plan D (I have to have medicane and cant really go without or sociaty at large would not like it .) Even with that you will have to have a drug plan medicare will pick one for you and send you the bill or take it out not sure which ..I know this because my daughter is also on medicare and they told her to pick or they would ,lucky or her or unlucky depending on how you see it she does quilify for medicare as well as medicad. What to do What to do What to do ..
Sorry this is so long and forgive the typing errors need spell check around my neck.. lol
I know it’s a tough situation Teresa. Have you gone to http://www.medicare.gov and looked at all plan available in your area? Normally a PPO or HMO Advantage plan will be less than many PFFS plans and certainly less than a Medicare supplement. Also, the average cost nationwide for Part D is about $31. I’m not familiar with your area, but $100 for a stand alone plan seems a little high. Check out the Medicare site if you have not already and enter your specific information to see if you can find a Medicare plan that will be affordable.
For what it’s worth: I’m the medical claims and a/r mgr for 3 doctors. From October 1 until about March 1, this is my least favorite time re: work. Patients call here asking “what should I change to? I don’t like what I have now”. Our answer is always “Choose what fits your needs and your budget. If we’re contracted with it, we’ll take it, but please don’t have your agent call us and try to force a new contract on us for an insurance we don’t already take if we’re not their network of providers…”
After January 1, the real “fun” starts when patients start getting statements from us for their deductibles from the PFFS plans. “But the agent said I wouldn’t have to pay anything… call him and ask him!” Or traditional Medicare claims reject because “oops, I forgot to tell you I changed insurances”, or — my personal fav response — “Didn’t Medicare tell you they weren’t my primary anymore?”
I’m glad there choices for people out there, but please don’t get mad at your doctor’s office when the insurance doesn’t perform the way you think it should.
Also please know that just because you and your neighbor have a insurance with the same name, you may not have the same plan benefits, so again, please don’t get mad at your doctor’s office because their plan paid and you had “the exact same thing done” but yours didn’t pay.
And now let’s talk about the changes to our local Medi-Cal system, going to a Managed Care HMO format…. well, no let’s not. I can only handle so much in one day…
Happy New Years to everyone with a new health plan… I’m really on your side 
Jan, I’m happy to see you are keeping a sense of humor. I feel your pain. Medicare supplement plan N is a great alternative to a Medicare Advantage plan. You and your clients shouldn’t encounter any of the frustrations you mentioned with a Medigap policy.
This will not help if you are under 65 and disabled. If you get no extra help you can not afford medicare. I am dropping out as of 1/1/11.