Medigap Plan G vs Plan N and the Key Costs That Differ
Medigap Plan G vs Plan N: nearly every guide says a doctor can bill 15% above Medicare’s approved amount. CMS’s own fee schedule puts the cap at 9.25%.
In This Article
Plan G and Plan N cover identical benefits except in two ways. Which costs less depends on three numbers only you have.
Still choosing between a supplement and an all-in-one plan? Compare what Medicare Advantage and Medigap actually cost first. Down to these two letters? This page runs the arithmetic. Already hold Plan N? Skip to the switching section.
Why this is a money question, not a coverage question
A Medigap premium is one of the five separate bills Medicare sends, and the only one whose size you choose.
What this page decides
Not which plan is better. Which is cheaper for your visit count, your quotes, and your state.
ℹ️ Financial Disclaimer: This is general financial education, not personalized insurance, investment, tax, lending, or debt advice. It recommends no plan, insurer, or agent. Benefits are federally standardized; premiums, underwriting, and some state protections vary. Consult a licensed insurance agent, your free SHIP counselor, a CPA, or an attorney as your situation requires.
The only two differences between Plan G and Plan N
Plan G and Plan N cover identical benefits except in two respects.
- Part B excess charges — Plan G covers them in full; Plan N does not.
- Copays — Plan N charges a copay on some office and some emergency room visits; Plan G charges neither.
Everything else matches: Part A deductible and coinsurance, skilled nursing and hospice coinsurance, blood, foreign travel emergency. That is confirmed by Medicare’s Medigap benefit comparison chart.
What neither plan covers
🔍 How It Works: Federal standardization sets Medigap benefits, not the insurer. Every company’s Plan G is the same Plan G, so insurers compete only on price, service, and how they raise premiums as you age.
Neither covers the annual Part B deductible, prescriptions, dental, vision, or hearing. Drugs need a separate Part D plan.
What each plan leaves you to pay in 2026
Three numbers matter: the Part B deductible both plans leave you, the office copay, and the emergency room copay.
| 2026 cost | Plan G | Plan N | Key detail |
|---|---|---|---|
| Part B deductible | $283 | $283 | Identical — cancels out |
| Office visit | $0 | Up to $20 | Charged after the deductible |
| Emergency room visit | $0 | Up to $50 | Waived if admitted |
| Part B excess charges | Covered | You pay | See next section |
📊 Data Point: The 2026 Medicare Part B deductible is $283, up from $257 in 2025 — Source: CMS 2026 Medicare Parts A & B fact sheet. Copay ceilings: CMS/NAIC Product 02110.
Why the copays are smaller than they look
Both are ceilings, not flat charges, and not every visit triggers one. Your Part B premium is billed separately from either plan.
Part B excess charges: the risk Plan N doesn’t cover
A Part B excess charge is what a non-participating provider bills above the Medicare-approved amount when they don’t accept assignment.
Why the real ceiling is lower than 15%
Nearly every page says a doctor can bill 15% above the Medicare-approved amount. That overstates it, because the 15% applies to a reduced base.
🔍 How It Works: Medicare pays non-participating providers 95% of the fee schedule amount, then caps their charge at 115% of that reduced figure. Multiply it out: 1.15 × 0.95 = 1.0925. The ceiling is 109.25% of the participating amount — about 9.25% above it, not 15%.
That is CMS’s own fee schedule calculation, which states the 1.0925 multiplier directly.
How often this happens
Medicare says most providers accept assignment, and KFF finds roughly 98% of non-pediatric physicians participate. Even so, 9.25% of a large surgical fee is real money. And Plan G covers excess charges, not every bill: where a provider has opted out of Medicare, Medicare pays nothing and no Medigap plan helps.
How to run the break-even on your own numbers
Whether Plan N is cheaper depends on three inputs: your annual premium saving, your office visits, and your emergency room visits.
The numbers you need
- Both quotes for your ZIP code, from Medicare’s Medigap plan finder.
- Office and emergency room visits per year.
- Nothing else — the Part B deductible is identical, so it cancels.
A worked example
Suppose your quotes are $170 and $140 a month. Use your own numbers — these are illustrative only.
That $30 gap is $360 a year. Eight office visits at up to $20 is up to $160; one non-admitted emergency visit adds up to $50. Plan N finishes roughly $150 ahead, before excess charges. Your break-even is the annual saving divided by $20 — here, 18 visits.
✅ Action Step: Ask a licensed insurance agent or your free SHIP counselor: “Given my ZIP code and age, and whether this insurer rates by community, issue age, or attained age, what will each plan cost at 70 and at 75?” Rating method moves the break-even more than visit count.
Why switching later may not be an option
Many people treat Plan N as a low-risk trial. Federal law makes that assumption expensive.
Your one guaranteed window
Medigap Open Enrollment is a one-time six-month period starting the first month you have Part B and are 65 or older. In it, an insurer cannot refuse you, use medical underwriting, or charge more for pre-existing conditions.
What happens after it closes
Usually no federal right to switch remains unless a guaranteed issue right applies. Your Medicare enrollment windows run on a separate clock, and the annual Medicare Open Enrollment Period does not cover Medigap. If you already chose Plan N, this is worth knowing, not worth panicking over — a new policy carries a 30-day free look, and some states add protections.
✅ Action Step: Ask your State Health Insurance Assistance Program: “Does my state let me change Medigap plans later without health questions, and when?” See Medicare’s rules on buying a Medigap policy.
Three Plan N claims worth checking
“Eight states ban excess charges.” Some states restrict or prohibit them, but the statutes differ — some cap rather than eliminate. We could not source that list to any federal authority; it appears across carrier and broker sites, inherited rather than verified. Confirm with your state department of insurance.
“The average gap is $20 to $50 a month.” No current authoritative source publishes a national average. Pull your own quotes.
“The plans work the same everywhere.” Massachusetts, Minnesota, and Wisconsin operate under federal waivers with their own designs, so this comparison does not map cleanly there.
Common questions about Plan G and Plan N
1. What is the difference between Medigap Plan G and Plan N?
Plan G covers Part B excess charges; Plan N does not and adds office and emergency room copays. Ask a licensed agent to price both.
2. Does Plan N cover the Medicare Part B deductible?
No. Neither Plan N nor Plan G covers the Part B deductible, which is $283 in 2026.
3. How much is the Plan N office visit copay?
Up to $20 per visit, charged after you meet the Part B deductible. Not every visit carries one.
4. Do I pay the Plan N emergency room copay if I’m admitted?
No. The Plan N emergency room copay of up to $50 is not charged when the visit ends in admission.
5. What is a Medicare Part B excess charge?
It is what a non-participating provider bills above the Medicare-approved amount when they do not accept assignment.
6. Can a doctor really charge 15% more than Medicare approves?
Not against the participating fee schedule amount. CMS caps the limiting charge at 109.25% of it — roughly 9.25% above.
7. Does Plan G cover the Part B deductible?
No. Plan G covers Part B excess charges but leaves you the annual Part B deductible, exactly as Plan N does.
8. Is Plan N cheaper than Plan G?
Only if your annual premium saving exceeds your copays. Divide that saving by $20 for your break-even visit count.
9. Can I switch from Plan N to Plan G later?
You can apply anytime, but outside your six-month Medigap Open Enrollment Period insurers may use medical underwriting. Ask your SHIP counselor.
10. Do Plan G and Plan N cover prescription drugs?
No. No Medigap plan covers prescriptions, dental, vision, or hearing. Drugs require a separate Part D plan.
11. Which states don’t allow Part B excess charges?
Some restrict or prohibit them, but protections differ and some carry exceptions. Confirm with your state insurance department.
What to do next
Pull both quotes for your ZIP code from Medicare’s Medigap plan finder. Ask each doctor you see whether they accept assignment. Then note when your Medigap Open Enrollment Period ends, and call your SHIP counselor before it closes.
The arithmetic is yours to run, and now you have every number it needs.
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