Medigap Plan G vs Plan N: Costs, Coverage, and Trade-offs

After Parts A and B, the question that haunts every newcomer to Medicare is what fills the gaps. In practice the field narrows to two Medigap plans: Plan G — the most comprehensive supplement on the market — and Plan N — the cheaper one with a few well-defined differences. Choosing between them is not a matter of taste but of arithmetic: how often do you see doctors, which state do you live in, and what does the premium gap look like over ten years?

This guide breaks it down completely: the standardization that makes comparison possible at all, the three real differences, the break-even math, the pricing methods that reshape the ten-year picture, the golden enrollment window that erases medical questions, and who should choose which.

Why comparison works at all: standardization

Medigap plans are standardized federally: a Plan G from one carrier covers exactly what a Plan G from any other carrier covers — so the entire competition plays out in price and service, not in benefits. Comparing G with N is therefore comparing two fixed baskets sold at different prices, not comparing hand-built products. And comparing G with G across carriers is comparing a single number: the premium.

What both plans cover

On the costliest side — the hospital — G and N are identical: both pay the full Part A share, including the 2026 inpatient deductible of $1,736 per benefit period, the days 61–90 coinsurance of $434 per day, the lifetime reserve days at $868 per day, and skilled nursing days 21–100 at $217 per day. Both also pay the 20% of Part B charges that Original Medicare leaves on the patient — the most dangerous gap in the raw system, since 20% of a specialist's bill can exceed the entire hospital deductible.

The three real differences

• 1. Part B excess charges. A doctor who has not signed the assignment agreement may bill the patient up to 15% above Medicare's approved amount. Plan G pays those charges in full; Plan N leaves them with you. And here states settle the argument: more than ten states — including Connecticut, Massachusetts, New York, Ohio, Pennsylvania, Vermont, Washington, Arkansas, Rhode Island, and Minnesota — ban Part B excess charges outright, which zeroes this difference for their residents. Verify your state's status before doing any math.
• 2. Office visit copays. Plan N charges up to $20 per doctor visit and some qualifying outpatient visits. Plan G: nothing.
• 3. Emergency room copays. Plan N charges up to $50 for an ER visit that does not result in admission. Plan G: nothing.

That is the entire difference — no hidden clauses, no fine print: three small numbers traded against a monthly premium gap that can run tens of dollars.

Break-even math: when N wins

A hypothetical illustration: a Plan G at $165 per month versus a Plan N at $125 — a $40 monthly gap, $480 a year. Suppose your doctor bills excess charges of 15% on a $200 approved service: $30 per visit. Plan N stays cheaper as long as you need fewer than sixteen such visits a year; heavy use — chronic conditions, frequent specialists — flips the math to G. Add $20 per office visit (ten visits = $200) and $50 per non-admitted ER trip, and the picture tilts quickly toward G with usage — and stays with N in the healthy years.

Rule of thumb: light users in excess-charge-ban states lean strongly toward N; heavy expected users want G's predictability.

High-deductible Plan G

There is also a high-deductible version of Plan G: a lower monthly premium in exchange for an annually set federal deductible you pay out of pocket before the plan pays anything. It suits buyers who want catastrophic protection at a lower price and pay small claims in cash — and note, this is not an HSA moment: HSA contributions end once Medicare is in force.

Pricing methods and the ten-year picture

More important than year-one price is the price curve: (1) attained-age-rated — cheap now, rising automatically with each birthday; (2) issue-age-rated — rises with inflation, not your age, usually cheaper over the long run; (3) community-rated — one price for everyone in the area. The practical instruction: ask each carrier for its rate-increase history, not just today's quote, and compare over ten years — a plan $15 cheaper today can overtake its rival by year seven. And if you are still deciding between Original Medicare with a supplement and Medicare Advantage at all, start with our Medicare Advantage vs Medigap comparison.

The golden window: six months, no questions

Medigap Open Enrollment: the first six months you are both 65 or older and enrolled in Part B — during which any carrier must accept you for any plan, no medical underwriting, no declination, no waiting, whatever your health. After that window closes, carriers may ask health questions, decline, or surcharge. The working rule: make the decision inside the window, with your options mapped before your birthday month, not after.

Switching later, and state windows

Outside the golden window, switching G to N (or back) generally means medical underwriting, except in defined guaranteed-issue situations. But a number of states grant annual windows — “birthday” or anniversary rules that allow a same-carrier or like-benefit switch with no health questions during a set period each year, including California, Oregon, and a handful of others. Know your state's rule: it can make today's decision correctable tomorrow.

The questions to ask before signing

Because benefits are identical across carriers, the entire interview with a Medigap carrier is about money mechanics. Five questions: How is the plan rated — attained-age, issue-age, or community? What were the rate increases in each of the last three years? Is there a household or marital discount, and does it survive a spouse's death? Is there a discount for bank draft or electronic payment? And is the high-deductible Plan G available if the premium becomes a burden later? A broker who answers those five fluently is worth keeping; a call center that cannot answer them at all tells you what service will look like at claim time. And compare each answer across at least three carriers — the spread for the identical Plan G in one county can exceed a hundred dollars a month.

Who should pick which

• Choose G if: your usage is heavy or chronic, your state allows excess charges and you want full cost predictability, or you simply want one premium and no surprises.
• Choose N if: you are relatively healthy, you live in an excess-charge-ban state (the gap shrinks to the $20 and $50 copays), or the premium gap is large and you would rather pay small amounts as they occur.

How we can help

We price G and N across multiple carriers in your state, calculate local excess-charge exposure, and lay out the ten-year table before recommending anything. Call 855-277-7770 or 469-333-2220, or request a free consultation through our site — and start on our Medicare services page.

Educational notice: American Mutual Insurance Agency LLC is an independent licensed insurance agency providing general educational information only — not medical or legal advice. Deductibles and figures stated are the amounts adopted for 2026; the 2027 Part B premium has not been announced; state rules vary and change — verify them with us before deciding.