Plan G costs $120–$180/month and covers 100% of Medicare-approved costs after the $257 Part B deductible — no copays, no excess charge exposure. Plan N costs $90–$140/month but adds copays (up to $20/visit, $50/ER) and no coverage of Part B excess charges. For most new Medicare enrollees, Plan G delivers better value unless you are in excellent health with very few doctor visits per year.
Both Plan G and Plan N are federally standardized Medigap plans — meaning every insurer must offer identical coverage for the same plan letter. The only differences are premium and the two cost-sharing distinctions below.
| Feature | Plan G | Plan N |
|---|---|---|
| Part A hospital coinsurance | ✓ Covered | ✓ Covered |
| Part A deductible ($1,632 in 2026) | ✓ Covered | ✓ Covered |
| Part B coinsurance (20% of approved costs) | ✓ Covered | ✓ Covered |
| Part B deductible ($257 in 2026) | ✕ Not covered | ✕ Not covered |
| Part B excess charges | ✓ Covered | ✕ NOT covered |
| Doctor visit copay | None | Up to $20/visit |
| Emergency room copay | None | Up to $50/visit |
| Skilled nursing facility coinsurance | ✓ Covered | ✓ Covered |
| Foreign travel emergency (80%) | ✓ Covered | ✓ Covered |
| Typical monthly premium (age 65, female) | $120–$180 | $90–$140 |
In plain terms: Plan G and Plan N are identical except Plan N adds a doctor visit copay, an ER copay, and removes coverage for Part B excess charges. In exchange, Plan N costs $25–$50 less per month.
Medigap premiums increase with age under most pricing methods. The table below shows typical 2026 monthly premium ranges for Plan G and Plan N for non-tobacco-using women (the most common enrollment profile). Men typically pay 5–15% more; tobacco users pay 10–50% more depending on the insurer.
| Age | Plan G (monthly) | Plan N (monthly) | Annual savings with Plan N |
|---|---|---|---|
| Age 65 | $120–$180 | $90–$140 | $360–$480 |
| Age 70 | $150–$220 | $120–$175 | $360–$540 |
| Age 75 | $185–$270 | $150–$215 | $420–$660 |
| Age 80 | $225–$330 | $185–$265 | $480–$780 |
These are national averages across multiple insurers. Premiums for the same plan can vary by 50% or more between insurers offering coverage in the same state, which is why comparing quotes is critical. Because all Plan G policies offer identical coverage, the only rational reason to choose a higher-premium insurer is financial stability and customer service reputation.
Plan G delivers the most value for people who use healthcare regularly and want complete cost predictability. After you pay the $257 Part B annual deductible — roughly $21/month amortized — you pay zero out of pocket for any Medicare-approved service. This makes your total annual healthcare cost completely knowable in advance: premium + $257. Nothing else.
Plan G is the right choice if you:
For people in these situations, the $25–$50/month premium difference between Plan G and Plan N is easily consumed by Plan N's copays within a normal year of healthcare use. Plan G eliminates the math problem entirely.
Plan N makes financial sense for people who are relatively healthy, see doctors infrequently, and whose doctors all participate in Medicare assignment. If you have 6–10 doctor visits per year and each generates a $20 copay, you're paying $120–$200 in copays annually — well below the $360–$480 in annual premium savings Plan N delivers compared to Plan G.
Plan N is the right choice if you:
The financial case for Plan N is strongest in the first years of Medicare enrollment, when most people are healthiest. As health needs increase with age, Plan G often becomes the better value — though switching from Plan N to Plan G later may be subject to medical underwriting in most states.
Part B excess charges are the charges doctors can legally bill above Medicare's approved payment rate when they don't accept Medicare assignment. Federal law caps excess charges at 15% above the Medicare-approved amount. For a procedure Medicare approves at $500, a non-participating provider can bill up to $575 — and Plan N enrollees pay that $75 difference out of pocket.
In practice, the excess charge risk is lower than it sounds. Approximately 96% of US healthcare providers accept Medicare assignment, meaning they agree not to charge above Medicare's approved rates. However, the risk is meaningfully higher in specific circumstances:
If you see specialists regularly or live in a high-cost urban market, the excess charge exposure of Plan N is a real financial risk. In most other situations, it's a minor concern that rarely materializes into actual out-of-pocket costs.
The premium gap between Plan G and Plan N varies significantly by state. In some states, the difference is under $20/month; in others, it exceeds $60/month, making Plan N dramatically more attractive financially. The states with the largest Plan G vs Plan N premium spreads in 2026 include:
| State | Plan G (age 65, female) | Plan N (age 65, female) | Monthly spread | Excess charge risk |
|---|---|---|---|---|
| New York | $280–$360 | $210–$280 | ~$70/mo | High (many specialists opt out) |
| Massachusetts | $190–$250 | $140–$195 | ~$50/mo | Low (state bans excess charges) |
| California | $175–$240 | $130–$185 | ~$45/mo | Moderate (urban specialists) |
| Florida | $155–$210 | $115–$165 | ~$40/mo | Low (high Medicare participation) |
| Texas | $140–$195 | $105–$155 | ~$35/mo | Low–moderate |
| Ohio | $125–$165 | $95–$130 | ~$30/mo | Moderate |
| Minnesota | $110–$150 | $90–$125 | ~$22/mo | Low |
Note: Minnesota, Massachusetts, and Wisconsin use their own standardized Medigap plan structures that don't map directly to the federal plan letters. In Massachusetts, both plans ban excess charges by law, making Plan N's coverage gap irrelevant.
The simplest way to decide between Plan G and Plan N is to calculate your break-even point. Assume Plan G costs $150/month and Plan N costs $115/month — a $35/month or $420/year premium difference.
With Plan N, you'd pay:
If you have 15 doctor visits per year at $20 each, that's $300 in copays — still $120 less than Plan G's premium premium. If you have 21+ doctor visits, the copays begin to exceed the savings. Most 65-year-olds average 7–9 outpatient visits per year according to CMS data — well within Plan N's break-even range.
The calculus changes if your health deteriorates. People with chronic conditions who see doctors 20+ times per year are better served by Plan G's flat-cost model. This is why many advisors recommend starting with Plan G during your Open Enrollment Period — when guaranteed issue rights mean you can get Plan G at any price — and locking in the coverage before health changes close your options.
If you enroll in Plan N during your Medigap Open Enrollment Period (the 6 months starting when you turn 65 with Part B), you have guaranteed issue rights. You cannot be denied coverage or charged more due to health conditions during that window.
If you decide to switch from Plan N to Plan G after that window closes, you will generally be subject to medical underwriting in most states — meaning an insurer can deny you Plan G or charge a higher premium based on your health history. If your health has deteriorated, you could be stuck with Plan N even if Plan G would now be the better financial choice.
This asymmetry — the one-time nature of guaranteed issue rights — is why many Medicare counselors suggest that people who are on the fence should choose Plan G at enrollment rather than Plan N. The downside of choosing Plan G if you turn out to be healthy is modest (a few hundred dollars per year in unnecessary premium). The downside of choosing Plan N if your health worsens is potentially being locked out of Plan G coverage entirely.
For most new Medicare enrollees, Plan G is better. The guaranteed-issue window at age 65 is your one opportunity to lock in comprehensive Medigap coverage regardless of health. Plan N makes sense for genuinely healthy people with few doctor visits and providers who all accept Medicare assignment — but the long-term risk of being unable to switch to Plan G later tips the scales toward Plan G for most people.
Yes, but in most states you'll need to pass medical underwriting after your initial Open Enrollment Period ends. An insurer can deny you Plan G or charge a higher premium based on health conditions. A few states (California, Oregon, Missouri, Illinois, and others) have birthday rules that let you switch plans annually without underwriting. Check your state's rules before choosing Plan N if there's any chance you'll want to upgrade later.
Yes. Plan N covers Part A hospital coinsurance (and up to 365 additional days after Medicare benefits are exhausted), the Part A deductible ($1,632 in 2026), and skilled nursing facility coinsurance. The copays only apply to outpatient doctor visits and emergency room visits that don't result in admission. If you're admitted to the hospital from the ER, the $50 ER copay is waived.
Plan G is significantly more popular. As of 2025 CMS data, Plan G had more than 5 million enrollees — roughly 3x as many as Plan N. This reflects both Plan G's comprehensive coverage and the fact that it replaced Plan F (which covered the Part B deductible) as the gold-standard plan for people new to Medicare after January 1, 2020. Plan N has grown in popularity as a cost-conscious alternative, but Plan G remains the dominant choice.
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