Medicare Plan N Warning: Are You Paying Hidden Fees?

Understanding Medicare Supplement Plans (Medigap)

Before diving into excess charges, let’s quickly go over how Medigap plans work. Medicare Supplement (Medigap) plans are designed to work alongside Original Medicare (Parts A and B). They help cover the out-of-pocket costs that Medicare doesn’t, such as deductibles, co-insurance, and co-pays.

Plan N is one of the most popular Medigap plans because of its lower monthly premium. However, it does come with some trade-offs:

• A co-pay of $0 to $20 for office visits
• A $50 co-pay for emergency room visits (waived if admitted to the hospital)
• No coverage for Part B excess charges

The last point—no coverage for excess charges—is where many Medicare beneficiaries run into unexpected costs. Let’s take a closer look at what that means.

What Are Medicare Part B Excess Charges?

When you visit a doctor who accepts Medicare, Medicare sets an approved amount for the service. However, some doctors can legally charge up to 15% more than what Medicare approves. This extra amount is called a Part B excess charge.

Since Plan N does not cover these charges, you are responsible for paying them out of pocket.

When Do Excess Charges Apply?

Excess charges only apply to Medicare Part B services, which include:

• Doctor visits
• Outpatient care
• Diagnostic tests (X-rays, MRIs, blood work, etc.)
• Medical equipment

If your doctor charges excess fees, you’ll have to pay up to 15% more than Medicare’s approved amount. That can quickly add up, especially if you have frequent medical visits.

How to Avoid Excess Charges

The good news is that not every doctor charges excess fees. Here’s how you can avoid them:

1. Choose Doctors Who Accept Medicare Assignment

Doctors who accept Medicare assignment agree to Medicare’s approved rates and cannot charge excess fees. If you go to a doctor who takes Medicare assignment, you won’t have to worry about excess charges.

You can find out if your doctor charges excess fees in two ways:

• Visit Medicare’s website: Go to Medicare.gov and use their physician lookup tool to check if your doctor accepts Medicare assignment.
• Ask your doctor directly: Simply call your doctor’s office and ask, “Do you accept Medicare assignment?” If they say yes, you’re in the clear.

2. Live in a State That Prohibits Excess Charges

Certain states have laws that ban excess charges altogether. If you live in one of the following states, you don’t need to worry about excess fees:

• Connecticut
• Massachusetts
• Minnesota
• New York
• Ohio
• Pennsylvania
• Rhode Island
• Vermont

If you have Plan N and live in one of these states, doctors cannot charge you more than the Medicare-approved amount.

3. Consider a Medicare Supplement Plan That Covers Excess Charges

If you don’t want to worry about excess charges at all, Medicare Supplement Plan G might be a better fit. Plan G covers excess charges 100%, so you’ll never have to pay them out of pocket.

Agent Tip

While Plan G typically has a higher monthly premium than Plan N, it eliminates the risk of excess charges. If you visit doctors who charge excess fees frequently, the higher premium might be worth it.

Are Part B Excess Charges Common?

You might be wondering: How often do people actually get charged these fees?

In our 10+ years of helping thousands of Medicare beneficiaries, we rarely see clients get billed for excess charges on Plan N. That being said, it can happen, so it’s important to be aware of it.

The best way to avoid these charges is to always check ahead of time if your doctor accepts Medicare assignment. It takes just a few minutes but can save you hundreds of dollars in surprise medical bills.

Is Medicare Plan N Still a Good Option?

Yes! Plan N is a great Medicare Supplement plan for many people. It offers lower premiums than Plan G while still covering the major costs Medicare doesn’t. However, it’s important to understand the potential trade-offs:

• Lower premiums (compared to Plan G)
• Co-pays for office visits and ER visits
• No coverage for excess charges

If you’re considering Plan N, just make sure to:

• Check if your doctors accept Medicare assignment
• See if you live in a state that bans excess charges
• Decide if you’re comfortable with the small risk of excess charges

If you follow these steps, you can still enjoy the savings of Plan N without unexpected fees.

Need Help Choosing the Right Medicare Plan?

Choosing the right Medicare plan is one of the most important decisions you’ll make for your health and finances. If you need help deciding whether Plan N, Plan G, or another Medicare option is best for you, we’re here to help!

Call us at 800-208-4974 to book a free Medicare consultation. Our services are 100% free, and we’ll make sure you get the best plan for your needs.