Understanding Medigap Plan N in North Carolina

What Does Medigap Plan N Cover?

Preventive Care (Medicare Coverage)

When you're visiting your doctor, Medicare provides complete coverage for your standard preventative care, such as screenings for cancer or diabetes. It also covers annual wellness visits, vaccines, and other types of tests recommended by your doctor. These preventive services are covered at 100% by Medicare Part B with no cost-sharing.

Medical Services Coverage

In addition, Medigap Plan N provides coverage for visits to your doctor because of injuries and illnesses. This coverage includes:

• Ambulance rides

• Durable medical equipment

• Surgeries

• Lab work and diagnostic tests

• Home health care

• Outpatient procedures

• Physical and occupational therapy

• Mental health services

How Medigap Plan N Works with Medicare

Medicare Supplement Plan N covers most of the 20% cost-sharing gap that Medicare Part B doesn't cover. Here's how it works:

1. Medicare pays

   the first 80% of approved charges

2. Your Medigap Plan N pays

   most of the remaining 20%

3. You pay

   small copays for certain services (see details below)

Medigap Plan N also helps to pay for hospital copays and deductibles. You'll be required to pay your Part B deductible and a few minor copays when visiting the emergency room or your doctor's office.

Complete List of Medigap Plan N Benefits

Medigap Plan N covers:

✅ Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted)

✅ Medicare Part A deductible ($1,676 in 2025)

✅ Medicare Part B coinsurance (usually 20% of approved charges, minus copays)

✅ Part A hospice care coinsurance

✅ Skilled nursing facility coinsurance ($197.50 per day for days 21-100 in 2025)

✅ First three pints of blood for any medical procedure each year

✅ Foreign travel emergency coverage (up to plan limits: 80% of costs after $250 deductible, up to $50,000 lifetime maximum)

What Medigap Plan N Does NOT Cover:

❌ Medicare Part B deductible ($257 in 2025)

❌ Part B excess charges (when doctors charge more than Medicare-approved amounts)

❌ Office visit copays (up to $20 per visit)

❌ Emergency room copays ($50 per visit, waived if admitted)

How Much Does Medigap Plan N Cost in North Carolina?

Many Medigap plans offer similar benefits. For example, your Medigap Plan N provides nearly the same benefits as Medigap Plan G, but with lower monthly premiums. The key difference is that you're responsible for paying a few small costs you wouldn't have to pay with Plan G.

Monthly Premium

Medigap Plan N premiums in North Carolina typically range from $90 to $170 per month, depending on:

• Your age

• Your location (county)

• Your gender

• Tobacco use

• Insurance company

• Household discount (if applicable)

Plan N is usually 15-30% less expensive than Plan G, making it an attractive option if you don't visit the doctor frequently.

Out-of-Pocket Costs with Plan N

Annual Costs You'll Pay:

1. Part B Deductible:

   $257 per year (2025)

2. Doctor Visit Copays:

   Up to $20 per office visit

3. Emergency Room Copays:

   $50 per ER visit (waived if admitted to hospital)

4. Part B Excess Charges:

   Up to 15% above Medicare-approved amounts (only if you see non-participating providers)

Example: Annual Cost Comparison

Scenario: 67-year-old non-smoker in Charlotte, NC with 12 doctor visits per year

Bottom Line: If you have minimal doctor visits, Plan N saves money. If you visit the doctor frequently, Plan G might be better value.

Understanding Part B Excess Charges

Under Medigap Plan N, you're responsible for paying Part B excess charges to medical providers. This occurs when providers don't accept Medicare assignment and can charge up to 15% more than what Medicare approves.

Example:

• Medicare-approved amount for a procedure: $1,000

• Medicare pays: $800 (80%)

• Provider charges excess: $150 (15% of $1,000)

• Plan N pays: $200 (the 20% coinsurance)

• You pay:

  $150 (the excess charge)

How to Avoid Excess Charges:

✅ Check if your providers accept Medicare assignment before appointments ✅ Use Medicare's Physician Compare tool at Medicare.gov ✅ Ask your doctor's office: "Do you accept Medicare assignment?"

Good News: In North Carolina, the vast majority of doctors (95%+) accept Medicare assignment, making excess charges rare. Additionally, eight states prohibit excess charges entirely (NC is not one of them, but excess charges are uncommon here).

Is Medigap Plan N Right for You?

Plan N is a Great Choice If You:

✅ Want lower monthly premiums than Plan G ✅ Don't visit the doctor frequently (fewer than 10-12 times per year) ✅ Are comfortable paying small copays for office visits ✅ Use providers who accept Medicare assignment ✅ Want comprehensive coverage with predictable out-of-pocket costs ✅ Are in good health and mainly need coverage for unexpected major expenses

Consider Plan G Instead If You:

⚠️ Visit the doctor very frequently (15+ times per year) ⚠️ Want true first-dollar coverage with no copays ⚠️ Prefer absolute predictability in costs ⚠️ Have chronic conditions requiring frequent specialist visits ⚠️ Don't want to worry about Medicare assignment

Plan N vs. Plan G: Quick Comparison

*After copays

When Can You Enroll in Medigap Plan N?

Medicare Supplement Open Enrollment Period

Your best time to enroll is during your Medigap Open Enrollment Period, which:

• Begins when you first enroll in Medicare Part B

  and

  you're 65 or older

• Lasts for 6 months

• Guarantees you cannot be turned down regardless of health conditions

• Protects you from higher premiums due to pre-existing conditions

• Does not require medical underwriting

Example: If you turn 65 in June and enroll in Part B effective June 1, your Medigap Open Enrollment runs from June 1 through November 30.

Guaranteed Issue Rights

You also have guaranteed issue rights (can't be denied) if you:

• Lose employer coverage

• Move out of a Medicare Advantage plan's service area

• Your Medicare Advantage plan leaves Medicare

• Your Medigap company goes bankrupt

Outside Open Enrollment?

If you apply outside these periods, insurance companies can:

• Require medical underwriting

• Deny coverage based on health conditions

• Charge higher premiums based on health history

Important: North Carolina does not have an annual Medigap open enrollment period. The federal 6-month window when you turn 65 is your primary opportunity for guaranteed acceptance.

How to Choose the Right Medigap Plan in North Carolina

Step 1: Calculate Your Expected Healthcare Usage

Estimate your annual:

• Doctor visits (primary care and specialists)

• Emergency room visits

• Prescription costs (separate Part D needed)

• Medical procedures or treatments

Step 2: Compare Total Annual Costs

Use this formula:

Annual Cost = (Monthly Premium × 12) + Part B Deductible + Expected Copays

Compare Plan N vs. Plan G based on YOUR expected usage.

Step 3: Check Provider Acceptance

• Call your current doctors

• Ask: "Do you accept Medicare assignment?"

• If yes to all, excess charges won't be an issue with Plan N

Step 4: Get Quotes from Multiple Companies

Medigap Plan N benefits are standardized (identical across all companies), but premiums vary significantly:

Charlotte Example (Age 65, Female, Non-Smoker):

• Company A: $98/month

• Company B: $135/month

• Company C: $152/month

Same benefits, different prices. Shop around!

Need Help with Medigap Plan N?

Talking to an experienced and local health insurance agent specializing in North Carolina Medigap plans means you can find the plan that suits you best. We can help you:

✅ Compare Plan N vs. Plan G for your specific situation ✅ Calculate your total expected costs based on your health needs ✅ Get quotes from multiple highly-rated insurance companies ✅ Enroll during your optimal window ✅ Understand your guaranteed issue rights ✅ Navigate the Medicare Supplement open enrollment period

Health Plans of NC serves residents across North Carolina, including:

• Charlotte and Mecklenburg County

• Raleigh and Wake County

• Durham and Durham County

• Greensboro and Guilford County

• Winston-Salem and Forsyth County

• And all 100 NC counties

Get Your Free Medigap Plan N Quote

If you need quotes for Medigap insurance and want to find out about the best Medigap plans for you, get in touch with our agents today.

Call: (800) 797-0327

Hours: Monday-Friday, 8AM-5PM EST

Service Area: All of North Carolina

Frequently Asked Questions About Medigap Plan N

Q: Can I switch from Plan N to Plan G later? A: Yes, but you may need to go through medical underwriting unless you have guaranteed issue rights. It's best to choose carefully during your initial enrollment period.

Q: Does Plan N cover prescription drugs? A: No. You need a separate Medicare Part D plan for prescription drug coverage.

Q: What if I can't afford the doctor visit copays? A: Consider Plan G instead, which has no copays. The higher premium might be offset by eliminating copays if you visit the doctor frequently.

Q: Are the $20 copays charged for every doctor visit? A: Yes, up to $20 per office visit for non-preventive care. Preventive services covered by Medicare Part B remain at $0 copay.

Q: What about urgent care copays? A: Plan N charges the $50 emergency room copay for urgent care facilities classified as ERs. Standard office copay ($20) may apply at non-ER urgent care.

Q: Can I add dental or vision coverage to Plan N? A: Medigap plans don't include dental or vision. You'd need separate dental and vision insurance policies.

Need personalized guidance on Medigap Plan N in North Carolina? Contact Health Plans of NC today for expert, local assistance.