Medigap Plan N and Plan F are supplemental insurance policies that each offer similar benefits. These plans pay for some out-of-pocket expenses due to coverage gaps in Original Medicare.
Original Medicare is federally funded health insurance coverage for adults ages 65 years and over, as well as adults with specific medical conditions.
It includes Part A and Part B, which cover inpatient hospital stays and outpatient services, such as diagnostic tests, certain procedures, and preventive care.
Although Original Medicare covers certain healthcare needs, it does not entirely cover the costs of services, so out-of-pocket costs usually apply. That is where a Medigap plan can help. Medigap Plan N and Plan F offer very similar benefits, but some differences and rules exist.
This article will look at Medigap plans, both Plan N and Plan F coverage, and alternative options that may be available.
Medicare coverage is extensive, but it does not pay for all healthcare expenses. A person may be required to cover some costs themselves.
These out-of-pocket costs can include:
- deductibles
- coinsurance
- copayments
- excess charges
Medigap plans, also known as Medicare supplement insurance, pay for some of these expenses. An individual may purchase a Medigap plan to help cover these costs.
To qualify for Medigap, an individual must have Original Medicare coverage.
Private insurance companies administer Medicare supplement plans, and people who choose Medigap pay a monthly premium to the insurer. The Medicare Part B premium is still payable to Medicare.
Currently, 10 different Medicare supplement plans are available. Letters of the alphabet indicate different plans.
The federal government sets standards for Medicare supplement plans in most states. This means that regardless of the location, the same letter plan must offer the same benefits.
All states are standardized in the same way, except for:
Coverage varies by plan. Two plans that offer similar coverage are Medigap Plan F and Plan N.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medigap Plan F covers many of the costs not provided by Original Medicare (Part A and Part B). Costs covered with Plan F include:
- Part A deductible
- Part A coinsurance
- Part B deductible
- Part B copays and coinsurance
- Part B excess charges
- skilled nursing care coinsurance
- health coverage outside of the United States, up to 80%
- first 3 pints of blood used in a procedure
Medigap Plan N offers similar coverage to Plan F, with a few exceptions.
Healthcare professionals may charge up to 15% more than Medicare allows. Medicare will cover the costs up to the approved amount, and some supplement plans cover the remaining excess amount. Medicare Plan N does not cover these excess charges.
Additionally, Plan N does not cover the Medicare Part B deductible. Medigap Plan N covers 100% Part B coinsurance except for up to $50 for emergency room visits that do not lead to an inpatient hospital admission and $20 for some doctor’s office visits.
When choosing the right Medigap plan, an individual may like to consider budget, health conditions, and medical requirements.
A side-by-side comparison of Medicare Plan N and Plan F may help people determine the best plan for their needs.
| Plan benefits | Plan N | Plan F |
|---|---|---|
| Part A coinsurance | yes | yes |
| Part B coinsurance | yes | yes |
| first 3 pints of blood | yes | yes |
| Part A hospice coinsurance | yes | yes |
| skilled nursing care coinsurance | yes | yes |
| Part A deductible | 75% | yes |
| Part B deductible | no | yes |
| Part B excess charge | no | yes |
| foreign travel exchange | 80% | 80% |
| out-of-pocket limit | — | — |
Starting in January 2020, Medicare adjusted Medigap plans, and they can no longer cover Medicare Part B deductibles. Due to the change, those newly eligible for Medicare can no longer choose Plan F, since it covers the Part B deductible.
People who were already enrolled in Plan F before the 2020 change may keep their plan. Medicare Plan N is available for purchase to new enrollees, as well as people already enrolled.
Individuals who live in Wisconsin, Minnesota, and Massachusetts should check plan availability with their state due to the difference in the standardization of supplemental insurance.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
For a person who is unable to enroll in Plan F or who decides that Plan N is not appropriate, alternative options exist.
Several other Medicare supplemental plans are also available, including A, B, D, G, K, L, and M.
Plans differ in coverage, including the percentage of Part B coinsurance covered. A person can compare plans using the online tool on the Medicare website.
A popular alternative to Plan F is Plan G. Plan G covers all the same benefits as Plan F, except it does not cover the Medicare Part B deductible.
Medicare Advantage
Instead of a Medigap plan along with Original Medicare, a person may choose to enroll in Medicare Advantage (Part C). A Medicare Advantage plan replaces Original Medicare and bundles together all the services covered in parts A and B. It often includes Part D as well.
As with Medigap plans, private insurance companies that Medicare has approved administer Medicare Advantage plans.
In some cases, Medicare Advantage plans cover more services than original Medicare. A person is unable to have a Medicare Advantage plan with a Medigap policy.
Medicare supplement plans, also known as Medigap, provide additional coverage and fill in the gap for services that Original Medicare does not cover.
Various plans are available that cover deductibles, coinsurance, and copays.
When comparing Medigap Plan N and Plan F, many similarities exist. However, Plan N does not cover the Medicare Part B deductible or excess charges that Plan F does.
In 2020, rules changed, and Medicare supplemental plans can no longer cover the Part B deductible. This means that new enrollees cannot select Plan F, but other options are available.