Medicare Supplement Plan N: What the $20 Copay Really Means

A plain-English look at Plan N's office-visit and ER copays, and the exact CPT codes behind them.

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Plan N Basics
How the Copay Works
CPT Codes
ER Copay
2027 CMS Proposal
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Plan N Coverage Basics

Like Plan G, Medicare Supplement Plan N leaves you responsible for the annual Part B deductible ($283 in 2026). After that’s met, Plan N covers your Part A deductible and services, Part B coinsurance, and more. Two exceptions are worth knowing before you enroll: a copay of up to $20 for certain office visits, and a copay of up to $50 for certain emergency room visits.

Key takeaway: Plan N’s premium runs lower than Plan G’s in exchange for these two small, predictable copays. For most people who don’t see the doctor often, the savings outweigh the occasional $20 or $50 charge.

Still comparing Medicare Supplement options? Visit our Medicare Supplement plans page to see how Plan N fits alongside Plans G, F, and HD-G.

How the $20 Copay Actually Works

The $20 figure is a cap, not a flat fee. What you actually pay is your share of the Medicare-approved amount for that visit, the same 20% coinsurance Part B normally charges, up to that $20 limit.

Example: Your office visit has a Medicare-approved amount of $460, and you’ve already met your deductible. Medicare pays 80% ($368), leaving a $92 balance. With Plan N, you pay the $20 copay and your plan covers the remaining $72.

If the approved amount is only $80, the 20% coinsurance comes to $16, so that’s what you’d pay instead of the full $20.

Whether a visit triggers the copay depends on the CPT billing code your provider uses, not on how the visit felt to you. Your doctor codes it after the fact, so you usually won’t know beforehand if a given appointment will carry the copay.

Which CPT Codes Trigger the Copay?

Below are plain-language descriptions of the codes most often involved. You don’t need to memorize them; your Explanation of Benefits will show which one applied to your visit.

Office Visit Codes (up to $20 copay)

Code	What It Covers
90805	An older mental health code for individual psychotherapy (about 20–30 minutes) combined with medication management. This code was retired years ago and is no longer actively billed.
92002	Eye exam for a new patient, intermediate level: a focused look at a specific eye problem.
92004	Eye exam for a new patient, comprehensive level: a full evaluation of the visual system that may span more than one visit.
92012	Eye exam for an established patient, intermediate level: continuing care for a known issue.
92014	Eye exam for an established patient, comprehensive level: a full visual system re-evaluation.
99201	Lowest-level new-patient office visit. This code was retired in 2021; new-patient visits now start at 99202.
99202–99205	New-patient office visits, increasing in complexity. 99202 is the most straightforward; 99205 involves the most time or highest complexity.
99211–99215	Established-patient office visits, increasing in complexity. 99211 is a brief visit that may not require the doctor to be present; 99215 involves the most time or highest complexity.

Emergency Room Codes (up to $50 copay)

Code	What It Covers
99281	Lowest-level ER visit: a minor problem needing little to no decision-making, such as a wound recheck or a note for work.
99282	Low-to-moderate severity with straightforward decision-making, such as a minor injury or mild infection.
99283	Moderate severity requiring low-complexity decision-making.
99284	A more involved evaluation requiring moderate-complexity decision-making.
99285	Highest-level ER visit: high-complexity decision-making for the most serious presentations.

The Emergency Room Copay

A separate copay of up to $50 applies to ER visits billed under one of five specific codes, calculated the same way: based on the 20% Part B coinsurance for that visit. If you’re admitted as an inpatient straight from the ER, your care shifts to Part A coverage and the ER copay is waived.

Concerned About Being Billed for Two Visits Instead of One?

Some clients have asked about a CMS proposal that could change how same-day visits are billed. Here’s what it actually covers, and what it doesn’t.

Status: This is a proposed CMS rule, not yet finalized. It’s part of the Calendar Year 2027 Medicare Physician Fee Schedule (CMS-1848-P), released in July 2026. The public comment period closed September 14, 2026, and CMS is expected to issue a final rule later this fall. Nothing described here takes effect unless CMS finalizes it.

Under the proposal, when the same physician (or another physician in the same practice) bills a separately identifiable office/outpatient evaluation and management (E/M) visit on the same day as a procedure with a 0-, 10-, or 90-day global period, Medicare would pay the higher-valued of the two services at 100% and reduce the other to 50%.

This rule changes what Medicare pays the physician for the second service that day. It doesn’t change what patients are billed. Since your coinsurance is a percentage of the Medicare-approved amount, a lower approved amount for that second service would typically mean a smaller share for you, not a larger one.

The more realistic concern for patients is indirect. If the rule takes effect, some practices may start scheduling the E/M visit and the procedure on separate days instead of combining them, to avoid the payment cut. If that happens, you could end up with two appointments, and under Plan N, two separate up-to-$20 copays, where you previously had one combined visit. That’s a scheduling question worth asking your provider’s office directly once the rule is finalized, since it depends on how each practice responds.

Helpful Medicare Resources

We encourage you to review these official government resources as part of your Medicare decision.

🌐 Medicare.gov — Medigap Plans Explained
🌐 CMS — CY 2027 Physician Fee Schedule Proposed Rule

NISONA is an independent insurance agency and is not affiliated with Medicare or the Centers for Medicare & Medicaid Services.

Have Questions About Your Plan N Coverage?

If you’ve received a bill or Explanation of Benefits and aren’t sure why a copay applied, our local NISONA advisors can help you understand the coding behind it, at no cost to you.