Medicare Supplement Plans - M, N

[Mack]

We have examined Medicare Supplement Plans A, B,C. D, F, G, K and L. It's take to take a look at the last two currently offered, Plans M and N. Like the other plans this info is for 2011:


Plan M Covers:

Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Medicare Part B Coinsurance or Copayment
First 3 pints of Blood
Part A Hospice Care Coinsurance or Copayment
Skilled Nursing Facility Care Coinsurance
50% of Medicare Part A Deductible
Foreign Travel Emergency up to plan limits


Plan N Covers:

The same as Part M except:
Pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Pays 100% of Medicare Part A Deductible

 

[gregl]

Plan N provides cost-sharing features that lower their premium in comparison with such standard plans as F and G. Its cost is about 70% of the Plan F cost. The Plan N is as good as Plan F, except:
• It does not pay Part B Annual Deductable
• It does not pay Part B Excess Charges
• It does not cover Foreign Travel Emergency
• It pays 100% of the Part B coinsurance except up to $20 copayment for office visits and up to $50 for emergency department visits

In other words, the most critical Medigap benefits (Part A coinsurance and deductable, and Part B coinsurance) are fully covered with $20/$50 copayments described above. And these copayments result in substantial Plan N premium savings compare with other Medigap plans.

When Plan N is a good value?
• For anyone in good health who only visit doctor occasionally and doesn’t want to be 'over-insured'
a) It may be the person who has Original Medicare and is ready to enroll into Medigap Plan in order to cover what Medicare does not pay (i.e. 20% of the original bill, without maximum limit).
b) Alternatively, it may be a client who is enrolled into expensive Medigap Plan and is considering switching to more affordable Plan N.
Let’s again emphasize that it does not pay to save a few hundred dollars in premium, if the client is visiting doctor quite often (let’s say twice a month) and is paying Plan N copayment - $20 for each visit.

• For those who are enrolled into Medicare Advantage and would like to return back to Original Medicare, the affordable Plan N (compare with Plans C or F) may be an attractive option. No more network restrictions and superior coverage – not bad for affordable premium and small copayments.

 

[classof63]

Plan N is what I signed up for with AARP. I usually go to the doctor about 4 times a year so I figured it would be cheaper to pay a $20 copayment 4 times a year than to pay the larger premiums every month.

I got it through AARP and signed up online and the process went very smooth and I got my card rather quickly, I think. I haven't used it yet but don't expect any problems.

 

[ladair13]

Plan N says ", uo to $20 copay for some hospital. How is amount of copay determined and if it falls wihtin "some" definition

 

[Mack]

I think that the copay amount for Plan N is set at $20 per visit. The copay amount is set by the plan in other words.

 

[ladair13]

The verbage on Medicare site says up to $20 copay on some office visits. Plan attributs are defined by Medicare in a standard way. There must be some explanation for "some" office visits and "up to" .

 

[Allan Ostling]

The Plan N is as good as Plan F, except:
• It does not pay Part B Annual Deductable
• It does not pay Part B Excess Charges
• It does not cover Foreign Travel Emergency

I bought (AARP) Plan N with the understanding that it does cover Foreign Travel. Was I misinformed?

 

[Mrs. Wilberforce]

Plan N is what I signed up for with AARP. I usually go to the doctor about 4 times a year so I figured it would be cheaper to pay a $20 copayment 4 times a year than to pay the larger premiums every month.

I got it through AARP and signed up online and the process went very smooth and I got my card rather quickly, I think. I haven't used it yet but don't expect any problems.

So it's been 2 years, how is plan N working for you, I think it sounds pretty good.

 

[weamish]

If you don't expect to be a significant consumer of medical services, I'd suggest going with the high-deductible version of plan F, where you can save even more premium while still providing yourself with catastrophe coverage.

 

[MBSC]

The verbage on Medicare site says up to $20 copay on some office visits. Plan attributs are defined by Medicare in a standard way. There must be some explanation for "some" office visits and "up to" .

Plan N members are responsible for the lessor of 20% of the Medicare allowed amount or $20 on the CPT codes for an office visit. The "up to" phrase is used because 20% of the allowed amount may be less than $20. The "some office visits" term is used because CPT office visit codes typically are not billed if you only go to receive a flu shot.

1. Question: Under Plan N, what constitutes an "office visit" for purposes of determining whether the subscriber is subject to the Part B coinsurance or copayment of up to $20?
Answer: Services coded as office visits or evaluation and management visits and billed on Part B professional claim forms (CMS-1500 or ASC X12N 837 professional) would be considered “office visits” for purposes of determining whether the subscriber is subject to the Plan N Part B coinsurance or copayment of up to $20. These include CPT-4 codes 99201 – 99205 and 99211 – 99215, as well as 92002, 92004, 92012, and 92014 (ophthalmology) and 90805 (psychotherapy).

2. Question: When applying the Plan N physician office copayment or coinsurance, should the amount be applied only to the office visit charge and not to other charges such as laboratory, x-ray or durable medical equipment (DME)?
Answer: Yes, the coinsurance or copayment should be applied only to CPT-4 codes 99201 – 99205 and 99211 – 99215, which are codes used to bill an office visit.