Medigap, decoded
Plan G vs. Plan N: which one actually saves you money?
Short answer: Plan N usually wins if the premium gap in your zip code is $30 a month or more and your doctors accept Medicare assignment. Plan G wins if you want zero bills after the deductible or see doctors constantly. Below: the full comparison table, the break-even arithmetic, the excess-charge risk by state, and the pricing detail that matters more than either plan’s sticker.
Key takeaways
- Plan G and Plan N cover the same core gaps in Original Medicare; the only benefit differences are Plan N’s copays (up to $20 office, up to $50 ER) and its lack of excess-charge coverage.
- Neither plan covers the $283 Part B deductible in 2026; that’s federal law for anyone newly eligible since 2020.
- At a typical $45-a-month premium gap, you would need about 27 office visits a year before Plan N costs more than Plan G.
- Eight states ban excess charges entirely, which removes Plan N’s main risk: NY, CT, MA, MN, OH, PA, RI, and VT.
- High-deductible Plan G is the third option: identical coverage after a $2,950 deductible in 2026, for a fraction of the premium.
What Plan G and Plan N both cover
Every Medigap plan letter is standardized by federal law, so a Plan G from one insurer pays exactly what a Plan G from another pays. G and N share the same spine: both pay the Part A hospital deductible ($1,736 per benefit period in 2026), the Part A coinsurance for long hospital stays, the 20% Part B coinsurance that Original Medicare leaves on every outpatient bill, skilled nursing facility coinsurance, the first three pints of blood, and 80% of emergency care abroad after a $250 deductible.
Just as important is what both give you structurally: they ride on Original Medicare, so there is no network, no referral requirement, and no prior authorization from the Medigap side. Any doctor in the country who takes Medicare takes your plan.
Neither plan covers the annual Part B deductible, which is $283 in 2026. Congress barred new Medigap plans from covering it starting in 2020, which is why Plan F, the plan that did cover it, is closed to anyone who became Medicare-eligible on or after January 1, 2020.
The two differences, and only two
Plan G
After you pay the $283 Part B deductible once for the year, Plan G pays essentially every Medicare-approved cost. No copays at the doctor, no copays at the ER. It also covers Part B excess charges: the up-to-15% surcharge that doctors who don’t accept Medicare’s approved amount are allowed to bill.
Plan N
Identical coverage, minus two pieces. You pay up to $20 per office visit and up to $50 per emergency room visit (waived if you’re admitted as an inpatient). And excess charges are not covered: if a doctor bills 15% above Medicare’s rate, that slice is yours.
Plan G vs. Plan N vs. high-deductible G at a glance
| Feature | Plan G | Plan N | High-deductible G |
|---|---|---|---|
| Part B deductible ($283) | You pay | You pay | Counts toward HD deductible |
| Office visit copay | None | Up to $20 | None after deductible |
| ER copay | None | Up to $50 (waived if admitted) | None after deductible |
| Part B excess charges | Covered | Not covered | Covered after deductible |
| Annual deductible | None beyond $283 | None beyond $283 | $2,950 (2026) |
| Typical national premium range, age 65 | $150–$300/mo | $120–$240/mo | $50–$80/mo |
| Best for | Heavy users, zero-surprise people | Assignment-accepting doctors, light users | Healthy people who want catastrophic cover |
Benefit structure per federal Medigap standardization; premium ranges are national estimates that vary by state, age, and insurer. Deductible amounts from CMS 2026 figures.
The break-even math, worked
Plan N typically runs $30 to $60 a month less than Plan G in the same market. Run a realistic example: Plan G at $220 a month, Plan N at $175. That premium gap hands Plan N a $540-a-year head start. At $20 per office visit, you would need 27 visits in a year before Plan N’s copays eat the savings. Even seeing a doctor monthly plus a couple of specialist follow-ups leaves you hundreds ahead on Plan N.
Three worked scenarios, same premiums as above:
- Light year (4 visits, no ER): Plan N total copays $80. You finish $460 ahead on Plan N.
- Medium year (12 visits, 1 ER without admission): copays $290. Still $250 ahead on Plan N.
- Heavy year (24 visits, 2 ER): copays $580. Now $40 behind. This is roughly the crossover, and it took a genuinely heavy year to get there.
The honest conclusion from the arithmetic: copays alone rarely decide this. What decides it is the next section.
Excess charges: Plan N’s real risk, and where it doesn’t exist
A doctor who accepts Medicare but not Medicare’s approved amount as full payment ("non-participating") may bill up to 15% above the approved amount. Plan G pays that; Plan N doesn’t. Most doctors accept assignment, so most people never see an excess charge. But certain specialties in certain markets are exceptions, and 15% of a large surgical or anesthesia bill is real money that arrives exactly when you’re least able to shop around.
Eight states prohibit excess charges outright: New York, Connecticut, Massachusetts, Minnesota, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live in one, Plan N’s main downside is legislated away and the case for N gets noticeably stronger. If you split time across states, remember the rule follows where care is delivered, not where you live.
One practical habit neutralizes most of the risk anywhere: before a planned procedure, ask "do you accept Medicare assignment?" It’s a yes/no question and offices answer it every day.
High-deductible Plan G: the third door
High-deductible Plan G is standard Plan G with a $2,950 deductible in 2026 in front of it. You pay Medicare-covered cost-sharing (the Part B deductible counts toward it) until you reach $2,950, then the plan pays like normal Plan G, excess charges included. Premiums often land between $50 and $80 a month nationally.
Think of it as true insurance rather than prepaid healthcare: in a healthy year you spend little; in a terrible year your Medicare-side exposure is capped at the deductible plus premiums. For someone with solid cash flow who mainly fears the catastrophic scenario, the total-cost math frequently beats both standard plans. The tradeoff is psychological as much as financial: you will see and pay real bills during the year.
The pricing detail that outlasts this year’s premium
Two Plan G quotes can age very differently. Insurers price Medigap three ways: attained-age (premium climbs as you age, cheapest at 65), issue-age (based on your age when you bought, rises only with inflation-type increases), and community-rated (everyone pays the same regardless of age). A cheap attained-age policy at 65 can overtake a pricier issue-age one by 75. When you compare quotes, ask which method each uses and ask for the insurer’s rate-increase history for the past three years. The plan letter fixes the benefits; the rating method shapes the next twenty years of bills.
The window matters more than the letter: whichever plan you choose, guaranteed acceptance at standard rates only lasts through your 6-month Medigap open enrollment window after Part B starts. Switching between G and N later usually means health questions in most states. Choose the structure you can live with for the long haul, not just the cheapest quote this year.
The verdict
Pick Plan G if you use a lot of care, see non-assignment specialists, or simply want a year with one predictable $283 bill and nothing else. Pick Plan N if your doctors accept assignment and the premium gap in your zip code is $30 a month or more; bank the difference. Pick high-deductible G if you’re healthy, liquid, and buying protection against disaster rather than routine bills. All three beat the most common method, which is picking whatever the first mailer offered.
Questions people also ask
What is the difference between Medigap Plan G and Plan N?
How much is the high-deductible Plan G deductible in 2026?
Does Plan N cover excess charges?
Can I switch from Plan N to Plan G later?
Is Plan G better than Medicare Advantage?
Sources for this article
- Medicare.govBuying a Medigap policy: standardized plans and the 6-month open enrollment window.
- CMS.gov2026 Medicare Parts A & B Premiums and Deductibles: the $283 Part B deductible and $1,736 Part A deductible used throughout.
- Medicare.govWhen can I buy a Medigap policy: timing rules and what happens outside the window.
Figures checked against these sources in July 2026. We update within weeks when CMS publishes new amounts.