When choosing a Medicare Supplement plan, cost is often a deciding factor. Medigap Plan N has gained popularity as an affordable option that still offers strong coverage. One of the key aspects that sets Plan N apart is its cost-sharing structure, specifically the copays required for certain medical services. Understanding these copays and how they impact out-of-pocket expenses is important for anyone considering this plan.
What Is Medigap Plan N?
Medigap Plan N is one of several Medicare Supplement plans (also called Medigap plans) designed to fill the coverage gaps left by Original Medicare (Part A and Part B). These gaps include deductibles, copayments, and coinsurance that beneficiaries would otherwise have to pay out of pocket. While Plan N provides substantial coverage, it differs from more comprehensive options like Plan G and Plan F in its approach to cost-sharing.
Plan N covers Medicare Part A coinsurance and hospital costs in full, as well as the Part A deductible, which is $1,676 in 2025. It also covers the 20% coinsurance that Medicare Part B typically requires for outpatient services. However, Plan N does not cover the Part B deductible, which is $257 in 2025, nor does it pay for Part B excess charges—additional costs that some doctors charge above Medicare-approved amounts.
Understanding Plan N’s Cost Structure
One of the most attractive aspects of Plan N is its lower monthly premium compared to other Medigap plans, particularly Plan G and Plan F. In exchange for these lower premiums, beneficiaries agree to cover certain out-of-pocket costs, primarily in the form of copays for doctor and emergency room visits. For those who don’t visit the doctor frequently or require frequent emergency care, Plan N can be a cost-effective alternative to more expensive plans with no copays.
How Do Plan N Copays Work?
Plan N requires beneficiaries to pay a $20 copay for some doctor’s office visits and a $50 copay for emergency room visits that do not result in hospitalization. These copays may seem minor, but they can add up for individuals who require frequent medical care. Let’s break down each of these cost-sharing aspects.
Doctor Visit Copays
Under Plan N, a $20 copay applies to certain doctor’s office visits. This means that if you see your primary care physician or a specialist, you may need to pay $20 per visit. However, not all visits are subject to this copay. Preventive care services that Medicare covers at 100%, such as annual wellness visits, are not subject to the $20 copay. Additionally, if you receive care from a provider who does not charge excess fees, your costs are limited to the copay alone, without additional charges.
For beneficiaries who visit the doctor frequently—whether for chronic conditions, routine follow-ups, or specialist care—these copays can add up over time. However, for those who only need occasional medical care, the savings from lower premiums may outweigh these minor out-of-pocket expenses.
Emergency Room Copays
Plan N requires a $50 copay for emergency room visits, but this fee is waived if the patient is admitted to the hospital. This copay is meant to discourage unnecessary ER visits for non-emergency issues. While $50 may not seem significant, repeated emergency room visits can result in noticeable costs. For individuals who experience frequent health emergencies, this is an important consideration. Urgent care visits do not count as true emergency room visits, so if you can see an urgent care doctor rather than going to the emergency room, you will save on the copy. (Though we would never discourage someone going to the emergency room when necessary!)
What Plan N Does Not Cover
While Plan N offers strong coverage, it does not pay for everything. One of the most significant exclusions is the Medicare Part B deductible. As we mentioned, in 2025, this deductible is $257, meaning beneficiaries must pay this amount out of pocket before Medicare begins covering their outpatient medical expenses.
Another key exclusion is Part B excess charges. Some healthcare providers charge more than the Medicare-approved amount for their services. While many doctors accept Medicare assignment and do not bill excess charges, those who do can charge up to 15% more than Medicare’s standard rate. Because Plan N does not cover these excess charges, beneficiaries who visit doctors who impose them will need to pay the additional costs themselves. To avoid this, it’s best to confirm that healthcare providers accept Medicare assignment before receiving care.
Weighing the Pros and Cons of Plan N Copays
The cost-sharing structure of Plan N makes it an appealing option for many Medicare beneficiaries, but it’s important to weigh the advantages and disadvantages before enrolling. One of the biggest advantages of Plan N is its lower monthly premium compared to Plan G and Plan F. For those who do not require frequent medical care, the savings on premiums can more than offset the occasional copays. Additionally, Plan N offers comprehensive hospital coverage, ensuring that inpatient care remains affordable.
On the downside, the copays for doctor visits and emergency room visits can add up, particularly for individuals with ongoing health conditions requiring frequent medical attention. Another consideration is the lack of coverage for excess charges, which can be an issue for beneficiaries who see specialists or providers who do not accept Medicare assignment. Unlike Plan G, which covers these excess charges, Plan N requires enrollees to either pay them out of pocket or find providers who do not impose them.
Who Should Consider Plan N?
Plan N is best suited for individuals who are relatively healthy and do not require frequent medical visits. If you only see your doctor occasionally and do not anticipate needing emergency care often, the lower monthly premium of Plan N can provide significant savings compared to more comprehensive Medigap plans. Additionally, Plan N is a good choice for those who are willing to confirm that their healthcare providers accept Medicare assignment, thereby avoiding excess charges.
On the other hand, those who anticipate frequent doctor visits, rely on specialists who charge excess fees, or have chronic health conditions may find that the copays and potential excess charges make Plan N less cost-effective. In such cases, Plan G may be a better option, as it eliminates the risk of excess charges while still offering strong coverage.
Learn More About Plan N
At Carolina Senior Benefits, we specialize in helping Medicare beneficiaries find the best coverage to suit their individual needs. Whether you’re considering Plan N or exploring other Medigap options, our team is here to guide you through the process and ensure you make an informed decision. Contact us today to discuss your Medicare Supplement plan options and find the coverage that works best for you.
