In short: Medigap Plan G and Plan N both fill most of the gaps in Original Medicare, and neither pays the Part B deductible. Plan N usually has a lower monthly premium, and in exchange you pay a copay for some office and emergency room visits and you are not covered for Part B excess charges. Plan G costs more each month and leaves fewer bills at the point of care. The comparison below shows how to work out which one costs you less over a year.
Key takeaways
Plan G offers fewer bills at the point of care; Plan N usually costs less each month in exchange for small copays. Both standardized policies cover 100% of the Medicare Part A hospital deductible, skilled nursing coinsurance, and hospice care. The core structural distinction rests on three points: Plan N requires up to a $20 copay per office visit, up to a $50 emergency room copay, and leaves Part B Excess Charges to the beneficiary. In exchange, Plan N premiums are usually lower than Plan G premiums from the same insurer. How much lower depends on your state, age and insurer, so compare actual quotes for your ZIP code.
When transitioning into Original Medicare (Part A and Part B), retirees quickly discover that traditional Medicare leaves real financial exposures: a Part A hospital deductible per benefit period, 20% Part B outpatient coinsurance with no cap, and no annual out-of-pocket maximum. To limit that exposure, millions of Americans purchase a private Medicare Supplement Insurance (Medigap) policy.
Since Congress eliminated Plan F for beneficiaries newly eligible after January 1, 2020, two standardized plans have become the most common choices for new Medigap enrollees: Plan G and Plan N.
Insurance advertisements often present this choice as a simplistic tradeoff: pay a higher premium for Plan G to never touch your wallet at a doctor’s office, or pay less for Plan N and handle occasional copays. In reality, choosing between these two federally standardized policies requires analyzing federal billing statutes, state consumer balance-billing protections, and the demographic risk pools that dictate compounding premium inflation over a ten-to-fifteen-year retirement horizon.
1. The Standardization Mandate: Why Insurer Brands Do Not Matter
Under Section 1882 of the Social Security Act (42 U.S.C. § 1395ss), Medicare Supplement plans are strictly standardized by CMS and the National Association of Insurance Commissioners (NAIC). Every lettered plan offers identical statutory coverage regardless of whether your card carries the logo of Mutual of Omaha, Aetna, Cigna, UnitedHealthcare, or a regional insurer.
A Plan G in Tampa, Florida provides the exact same legal benefits as a Plan G in Seattle, Washington. Private carriers cannot alter coinsurance rules, deny statutory claims approved by Medicare, or impose restrictive HMO networks. As long as a physician or hospital accepts Original Medicare, your Medigap policy works there regardless of the issuing carrier. (Massachusetts, Minnesota and Wisconsin standardize their plans differently, and some insurers sell network-based “Medicare SELECT” versions, so check what is offered in your state.) What does differ between companies is price, rating method and rate-increase history.
2. Direct Statutory Breakdown: Plan G vs. Plan N
To evaluate where your monthly premium dollars actually go, examine the exact regulatory benefit differences codified under federal law:
Side by side: Medigap Plan G vs. Plan N
| Statutory Medicare Benefit | Medicare Supplement Plan G | Medicare Supplement Plan N |
|---|---|---|
| Part A Hospital Deductible & Coinsurance | 100% Covered (Plan pays all hospital facility costs) | 100% Covered (Plan pays all hospital facility costs) |
| Skilled Nursing Facility Coinsurance | 100% Covered (Days 21–100 paid in full) | 100% Covered (Days 21–100 paid in full) |
| Hospice Care Coinsurance | 100% Covered | 100% Covered |
| Foreign Travel Emergency Care | 80% Covered (Up to $50,000 lifetime cap) | 80% Covered (Up to $50,000 lifetime cap) |
| Part B Outpatient Coinsurance (20%) | 100% Covered (Zero out-of-pocket copays) | Covered with copays (Up to $20/visit; up to $50/ER) |
| Annual Part B Deductible | NOT Covered (Beneficiary pays standard base) | NOT Covered (Beneficiary pays standard base) |
| Part B Excess Charges | 100% Covered | NOT Covered (Beneficiary pays up to 15%) |
| Monthly Premium | Usually higher (varies by state, age and insurer) | Usually lower (varies by state, age and insurer) |
3. Examining the Cost Drivers: Copays vs. Excess Charges
When financial planners evaluate whether Plan N delivers genuine savings over Plan G, they analyze two specific variables: outpatient visit copayments and Part B Excess Charge liability.
1. The Reality of Plan N Copayments ($0 to $20)
On Plan N, copayments are not charged across all medical services; they are tightly restricted to specific billing categories:
- Up to $20 Doctor Copay: Incurred only during office visits that result in an Evaluation and Management (E&M) coding charge. If you visit a medical clinic solely for physical therapy, lab draws, allergy injections, chemotherapy infusions, or routine diagnostic imaging (X-rays, MRIs), your copayment is $0.
- Up to $50 ER Copay: Charged only if you visit an emergency room and are discharged without being formally admitted as an inpatient. If the facility admits you to the hospital, the $50 copay is automatically waived.
- Urgent Care Visits: How a visit is billed determines whether the office-visit copay applies. Ask the clinic or your Medigap insurer if you are unsure.
2. The Part B Excess Charge Reality
Under federal law (42 U.S.C. § 1395u(j)), doctors who treat Medicare patients are categorized as either Participating Providers (who accept Medicare assignment and agree to CMS reimbursement rates) or Non-Participating Providers. Non-participating doctors can legally bill up to 15% above the Medicare-approved amount—a surcharge known as an Excess Charge.
While Plan G shields beneficiaries from excess charges completely and Plan N does not, excess charges are uncommon for most beneficiaries:
- The large majority of physicians and other practitioners who treat Medicare patients accept assignment, which means they do not bill excess charges. You can ask any office, “Do you accept Medicare assignment?” before you book.
- Several states restrict or prohibit Part B excess charges under state law; Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont are commonly cited. Rules can change, so confirm with your State Health Insurance Assistance Program (SHIP).
4. The Actuarial Driver: Long-Term Rate Increase Trends
The greatest financial hazard in selecting a Medicare Supplement policy is not what you pay at age 65, but what you will pay at age 75 or 80.
Medigap premiums generally rise over time, and the pace depends on the insurer’s claims experience, medical inflation and how the policy is rated (community-rated, issue-age-rated or attained-age-rated). Because Plan G pays more of the bill than Plan N, some advisers expect Plan G premiums to rise somewhat faster, but this is not guaranteed and varies by insurer and state.
Rather than rely on a rule of thumb, ask each insurer or a licensed agent for the plan’s rate-increase history in your state and which rating method it uses. A small difference in annual increases compounds over a long retirement, so this question matters as much as the starting premium.
5. A Hypothetical Example: The Annual Breakeven Calculation
The premiums below are hypothetical and are only meant to show how to run the comparison with your own quotes:
Retiree Profile: 65-year-old healthy retiree, non-smoker, visiting primary care and specialist physicians 8 times per year.
- Plan G Monthly Premium: $165/month ($1,980/year). Zero copays. Annual cost (excluding Part B deductible) = $1,980.
- Plan N Monthly Premium: $120/month ($1,440/year). Annual premium savings = $540/year.
- Plan N Copay Expenses: 8 doctor visits × $20 maximum copay = $160 in annual copayments. Zero excess charges incurred.
- Net Annual Financial Result: Plan N total cost = $1,600. Plan N costs $380 less for the year in this example ($1,980 − $1,600).
At these hypothetical prices, the $540 premium difference equals 27 office visits at the $20 maximum copay ($540 ÷ $20). Someone with more visits than that, or who sees providers that bill excess charges, could come out ahead on Plan G.
6. Timing Matters: Your Medigap Open Enrollment Period
For most people, the best time to buy either plan is the six-month Medigap Open Enrollment Period, which generally begins the month you are 65 or older and enrolled in Part B. During that window, insurers generally cannot refuse to sell you a policy or charge you more because of health conditions.
After that window, in most states an insurer can use medical underwriting, which means it can ask health questions and may decline your application or charge more. That has a practical consequence for this decision:
- Moving from Plan G to Plan N later (or the reverse) may require passing underwriting, unless you live in a state with extra protections or qualify for a guaranteed-issue right.
- Some states offer additional switching rights, such as annual “birthday rule” or anniversary windows, or year-round open enrollment. Your SHIP office can tell you what applies where you live.
- Leaving a Medicare Advantage plan can also trigger limited Medigap rights. See our guides on the Medigap trial right and switching back to Original Medicare from Medicare Advantage.
Because switching later is not always possible, choose the plan you would be comfortable keeping for many years, not just the one that is cheapest today.
7. Who Tends to Prefer Each Plan
Plan G may suit you if:
- You see doctors often and do not want a copay at each visit.
- You use, or may travel to, providers who do not accept Medicare assignment.
- You value predictable costs over the lowest premium.
Plan N may suit you if:
- You have relatively few office visits in a typical year.
- Your regular doctors accept Medicare assignment, or your state restricts excess charges.
- You are comfortable paying small copays in exchange for a lower premium.
Neither plan covers prescription drugs, routine dental, vision or hearing care, or long-term custodial care. Most people on Original Medicare add a separate Part D drug plan; the Medicare Plan Finder can help compare those.
8. Questions to Ask Before You Buy
Ask the insurer or agent:
- What is the monthly premium for Plan G and for Plan N at my age and ZIP code?
- Is the policy community-rated, issue-age-rated or attained-age-rated?
- What rate increases has this insurer filed for each plan in my state in recent years?
- Are household, non-tobacco or automatic-payment discounts available, and can they be removed later?
- Do my regular doctors accept Medicare assignment?
- If I want to change plans later, will I need to answer health questions?
9. Common Mistakes to Avoid
- Comparing only the first-year premium. Ask about rating method and rate history as well.
- Assuming a bigger brand means better benefits. Benefits for the same plan letter are standardized; price and service are what differ.
- Missing the open enrollment window. Waiting can mean underwriting later.
- Forgetting the Part B deductible. Neither plan pays it, so budget for it each year.
- Dropping a Medigap policy without confirming the replacement. Do not cancel existing coverage until the new policy is approved in writing.
Frequently Asked Questions
Does Plan N have a deductible of its own?
No separate plan deductible, but like Plan G it does not pay the annual Medicare Part B deductible. After that deductible is met, Plan N pays the Part B coinsurance except for the office-visit and emergency-room copays.
Can I switch from Plan N to Plan G later?
You can apply at any time, but outside your Medigap open enrollment period or a guaranteed-issue situation, most states allow the insurer to review your health history first. Some states have more generous rules.
Do Plan G and Plan N cover prescriptions?
No. Medigap policies sold today do not include drug coverage. You would need a separate Medicare Part D plan.
Is there a high-deductible version?
A high-deductible Plan G is offered in some states. It has a lower premium but requires you to pay a set deductible, adjusted each year, before the plan pays. Check Medicare.gov for the current amount.
Where can I get unbiased help comparing plans?
Your State Health Insurance Assistance Program (SHIP) offers free counseling, and Medicare.gov lists Medigap policies available in your area.
The Bottom Line
Both Medigap Plan G and Plan N provide strong protection against the gaps in Original Medicare and can be used with any provider that accepts Medicare. If you prefer the fewest bills and the most predictable costs, Plan G offers that simplicity. If you are comfortable paying an occasional copay, your doctors accept Medicare assignment, and the premium difference in your area is meaningful, Plan N can be the lower-cost choice. Get quotes for both, ask about rate history, and decide during your open enrollment window if you can.