Medicare Supplement Plan N is one of the most popular Medigap plans for people who want strong coverage at a lower premium than Plan G. Plan N pays your share of most Medicare costs but leaves two small out-of-pocket items in your hands: a copay of up to $20 for some office visits, and a copay of up to $50 for emergency room visits that don't end in a hospital admission.
That sounds straightforward until you actually go to the doctor. Does a specialist visit count? What about an x-ray drawn during the same appointment? Telehealth? Urgent care? The answer depends on the billing code your provider uses on the claim. The list below of what triggers a Plan N copay, and what doesn't, comes from the federal implementation guidance every Medigap carrier follows.
The two Plan N copays at a glance
- Up to $20 for each covered office visit, including visits to specialists.
- Up to $50 for each covered emergency room visit, waived if you're admitted to the hospital.
Both copays are written in the federal Medigap regulation as "the lesser of" $20 or $50 and the Part B coinsurance Medicare would otherwise bill. In most cases you'll pay the full $20 or $50, but on lower-cost visits the copay can be less. Either way, Plan N's copays only begin once you've met the annual Medicare Part B deductible ($257 in 2026). Until that deductible is satisfied, you pay the Part B coinsurance the same as any other Medicare beneficiary.
What triggers the $20 office visit copay
The federal guidance is specific: the $20 copay applies to services billed as an office visit or as an evaluation and management (E&M) visit on a Part B professional claim. In plain English, the trigger is the billing code on your provider's claim, not the kind of provider you see.
The CPT codes that trigger the Plan N office visit copay are:
- 99202-99205 and 99211-99215: standard E&M office visit codes for new and established patients.
- 92002, 92004, 92012, 92014: ophthalmology office visits.
- 90832, 90834, 90837, and add-on 90785: psychotherapy office visits.
Two practical points follow from that list. First, there is no separate "specialist" copay under Plan N. A cardiologist, dermatologist, or oncologist visit billed under the same E&M codes carries the same $20 copay as your primary care visit. Second, if you have two Medicare-covered office visits on the same day (say, your PCP in the morning and a specialist in the afternoon), each visit is its own copay.
What does not trigger the $20 copay
This is where most Plan N shoppers get tripped up. Many common services aren't coded as office visits and don't carry the copay, even if they happen in your doctor's office on the same day as a visit.
- Lab work, x-rays, imaging, and DME. The federal guidance is explicit: the copay applies only to the office visit charge itself. Bloodwork drawn during the visit, the x-ray taken down the hall, and durable medical equipment provided that day are billed as separate line items and are not subject to the Plan N copay.
- Outpatient surgery and ambulatory procedures. These are billed under procedure codes, not E&M codes. A colonoscopy, cataract surgery, or skin biopsy doesn't trigger the office visit copay.
- Urgent care. Urgent care centers use their own billing code, which is neither an office visit nor an ER visit. Under the federal guidance, neither the $20 office visit copay nor the $50 ER copay applies to urgent care.
- Telehealth, phone, and online patient portal visits. The 2010 federal guidance states that these services are not coded as office visits or E&M visits and therefore are not subject to the Plan N copay. Telehealth coding has expanded since the pandemic, so it's worth checking how your Medigap carrier processes telehealth claims, but the underlying federal rule still treats non-office E&M visits as outside the copay.
- Foreign travel emergency care. Plan N includes the standard Medigap foreign travel emergency benefit (80% of medically necessary emergency care abroad, up to plan limits). Because foreign claims don't have a U.S. National Provider Identifier and aren't processed through Medicare, the Plan N office and ER copays do not apply to them.
The $50 ER copay and when it's waived
The Plan N emergency room copay is up to $50 per Medicare-covered ER visit.
First, the $50 covers your total Part B share for the ER trip. An emergency room visit usually generates two claims: one for the ER facility and a separate one for the emergency physician's professional fee (CPT 99281-99285). Some shoppers worry they'll owe both the $20 office copay (because the physician codes look like E&M) and the $50 ER copay. They don't. The federal guidance treats the entire ER trip as one event, and the patient pays one Plan N copay of up to $50 against the total Part B coinsurance.
Second, the $50 is waived if you're admitted. If the ER visit results in an inpatient hospital admission and the care is paid under Medicare Part A, the Plan N ER copay must be waived. Once you're admitted, the ER visit becomes the start of a Part A inpatient stay, which Plan N already covers in full. If you visit the ER twice in one day without being admitted, the $50 copay applies to each visit.
The ER copay is $30 higher than the office visit copay on purpose. The regulators who wrote Plan N wanted to nudge people toward office and urgent care settings for non-emergencies.
Three things people get wrong about Plan N copays
- The Part B deductible comes first. Plan N does not pay your Part B deductible. Until you've satisfied the $283 deductible for 2026, you're paying the Part B coinsurance directly, just like any other Medicare beneficiary. Once the deductible is met, Plan N takes over and the $20 and $50 copays apply going forward.
- You don't pay both an office and ER copay on the same ER visit. Even though the emergency physician's professional charges look like office visit codes, the Plan N ER copay of up to $50 covers the whole encounter.
- The copays are "up to" amounts. The federal language is "the lesser of" the cap and the Part B coinsurance. On a low-cost office visit where the Part B coinsurance Medicare would have billed is less than $20, you pay the lower number. Most of the time you'll pay the full $20 or $50.
Quick reference: what triggers a Plan N copay
| Triggers a Plan N copay | Does not trigger a Plan N copay |
|---|---|
| Primary care office visit | Lab work, x-ray, imaging, DME |
| Specialist office visit (same $20 cap) | Urgent care center visit |
| Ophthalmology eye exam (E&M code) | Telehealth, phone, or online portal visit |
| Psychotherapy office visit | Outpatient surgery or ambulatory procedure |
| Emergency room visit not resulting in admission ($50) | Emergency room visit followed by inpatient admission |
| Each of multiple same-day office visits | Foreign travel emergency care |
How this compares to Plan G
Plan G is the other Medigap option most people compare against Plan N. Plan G has no office or ER copay, but its monthly premium is higher than Plan N's. Plan G also pays Part B excess charges, which Plan N does not. For someone who sees the doctor regularly but rarely goes to the ER, the math often comes down to how many office visits add up against the premium difference over the year. The full plan-by-plan layout is in my Medicare Supplement plan comparison, and the current Part B numbers are in 2026 Medicare costs and premiums.
Weighing Plan N for 2026?
Plan N's lower premium can be a good fit for people who don't expect many office visits, but the right answer depends on which carriers price well in your ZIP code and what your year looks like for doctor visits. I help Washington state shoppers compare quotes from the carriers I work with. If you'd like a no-pressure walkthrough of Plan N versus Plan G for your situation, reach out.
Copay amounts and CPT codes reflect federal guidance current as of publication. The Part B deductible updates annually, and CPT codes are periodically revised by the AMA and CMS. The Plan N copay structure itself is set by federal regulation and is the same across every Medigap carrier offering Plan N.