What is the main difference between Medigap Plan G and Plan N?

Both plans cover the 20% Medicare Part B coinsurance and the $1,736 Part A deductible. Plan G covers 100% of all medical bills after you pay the annual $283 Part B deductible. Plan N offers 20–30% lower monthly premiums, but requires up to $20 copays for office visits, $50 for ER visits, and does not cover Part B excess charges.

How do I know if Plan N will save me money over Plan G?

Calculate your annual premium savings (typically $240 to $600/year) and subtract your estimated Plan N copays ($20 per doctor visit and $50 per ER visit). If your annual doctor visit copays are less than your premium savings, Plan N saves you money.

What are Part B excess charges and how common are they?

Part B excess charges occur when a doctor does not accept "Medicare assignment" and legally charges up to 15% above the Medicare-approved amount. According to CMS and KFF data, over 97% of physicians nationwide accept assignment, making excess charges rare. Eight states ban excess charges entirely by law.

Which states prohibit doctors from billing Part B excess charges?

Eight states have passed BALANCE BILLING / MOM (Medicare Overcharge Measure) laws prohibiting doctors from charging Part B excess charges: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In these states, Plan N policyholders face zero excess charge risk.

Do Plan G and Plan N have different doctor networks?

No. Neither Plan G nor Plan N has any network restrictions. As standardized Medigap policies, both plans allow you to see any physician, specialist, or hospital in the United States that accepts Original Medicare. Insurers cannot restrict your provider choices on either plan.

Can I switch from Plan N to Plan G later if my health worsens?

In most states, switching from Plan N to Plan G after your initial 6-month Medigap Open Enrollment window requires medical underwriting. If you develop chronic conditions, insurers can deny your application or charge higher rates. A few states offer annual "birthday rule" or continuous guaranteed issue rights.

Are benefits for Plan G and Plan N identical across all insurance carriers?

Yes. By federal law, every Medigap Plan G offers the exact same government-standardized benefits regardless of which insurance company sells it. The same applies to Plan N. The only differences between carriers are monthly premium pricing, customer service, and annual rate increase history.

Where can I find free, unbiased advice on Medigap options in my state?

Your State Health Insurance Assistance Program (SHIP) provides free, unbiased, state-specific counseling from trained volunteers who do not earn insurance commissions. Find your local SHIP program at shiphelp.org or call 1-877-839-2675.

Free — No Account Required We Never Share Your Data Verified Against Official Government Sources

Last reviewed by the Seniors Audit research team on August 2026

Medigap Plan G vs Plan N: Break-Even Cost Calculator

Compare doctor visit copays and excess charge risks against monthly premium savings to find your lower-cost plan.

Quick Answer

Plan N typically saves $300 to $500 per year in premiums compared to Plan G. In exchange, Plan N requires copays up to $20 per office visit and $50 per ER visit, and does not cover Part B excess charges. If you visit the doctor fewer than 15 to 20 times per year, Plan N is almost always the lower-cost choice overall.

Plan G and Plan N are the two most popular Medicare Supplement options in 2026. While Plan G provides total 100% coverage after the $283 Part B deductible, Plan N offers substantially lower monthly premiums. This free calculator runs your personal doctor visit numbers to show whether the premium savings of Plan N outweigh the copay exposure.

What this comparison tool calculates:

Your projected annual Plan N copay costs based on office and ER visits
Net annual savings of Plan N after paying all copays
Break-even visit threshold where Plan G becomes more cost-effective
Analysis of Part B excess charge exposure and the 8 states with total bans
Standardized side-by-side coverage breakdown under official 2026 CMS rules

Calculate Your Plan G vs Plan N Break-Even Point

Enter your expected healthcare visits and local premium gap below. All math runs instantly in your browser.

FACT = Standardized statutory Medicare benefit. DECISION SUPPORT = Personalized financial break-even calculation.

Medicare Benefit Category	Medigap Plan G	Medigap Plan N	Rule Type
Part A Hospital Inpatient Deductible ($1,736)	✓ 100% Covered ($0 out-of-pocket)	✓ 100% Covered ($0 out-of-pocket)	FACT
Part B Annual Deductible ($283 in 2026)	You Pay ($283 once/year)	You Pay ($283 once/year)	FACT
Part B 20% Medical Coinsurance (Doctor/Outpatient)	✓ 100% Covered ($0 copays)	Covered except up to $20 per office visit	FACT
Emergency Room Copayment	✓ $0 Copay	Up to $50 copay (waived if admitted)	FACT
Part B Excess Charges (Up to 15% Surcharge)	✓ 100% Covered	✕ Not Covered (Rare; 0% in 8 states)	FACT
Skilled Nursing Facility Coinsurance (Days 21–100)	✓ 100% Covered ($217/day saved)	✓ 100% Covered ($217/day saved)	FACT
Foreign Travel Emergency Care (80% up to $50k)	✓ 100% Covered	✓ 100% Covered	FACT
Doctor & Hospital Network Restrictions	None — Any Medicare provider nationwide	None — Any Medicare provider nationwide	FACT

Your Medigap Plan Selection Action Plan

Follow these 6 steps to choose between Plan G and Plan N with total confidence:

Get real Plan G and Plan N quotes in your ZIP code. Use medicare.gov/plan-compare to see actual carrier pricing in your county. Check the dollar spread between the lowest-cost Plan G and Plan N.
Count your typical annual specialist and doctor visits. Review your previous year's appointment calendar. If you average 1–8 visits annually, Plan N's copay structure will save you hundreds over Plan G.
Check your state's balance billing laws. If you reside in CT, MA, MN, NY, OH, PA, RI, or VT, state law completely bans Part B excess charges, eliminating the primary coverage advantage of Plan G.
Evaluate your risk tolerance for paperwork. On Plan G, you never receive a bill or copay request after paying your Part B deductible. On Plan N, you pay $20 at doctor checkout. Choose Plan G if you want zero administrative hassle.
Review the carrier's rate increase history. Because Plan N attracts slightly healthier enrollees on average, its historical annual rate increases have been slightly lower than Plan G in many states.
Consult a free local SHIP counselor. Connect with a non-commercial State Health Insurance Assistance Program counselor at shiphelp.org or call 1-877-839-2675 before submitting your application.

How to Use This Calculator

Enter your expected annual doctor office visits
Estimate how many times you visit primary care physicians or specialists per year (national average for seniors is approximately 6 visits).
Enter expected emergency room visits
Input your expected ER visit frequency (default is 0.3, or roughly one ER visit every 3 years). Plan N waives the $50 copay if you are admitted as an inpatient.
Set the monthly premium difference
Enter the quoted monthly price gap between Plan G and Plan N in your area (typically $25 to $45/month depending on age and ZIP code).
Select your risk tolerance for excess charges
Indicate whether you live in a state that bans excess charges, or whether you are comfortable confirming assignment with doctors before procedures.
Review your personalized break-even math
The calculator displays your exact annual copay exposure vs premium savings, indicating which plan is mathematically superior for your usage profile.

Three Real-World Scenarios

Hypothetical scenarios illustrating when Plan N wins and when Plan G is worth the extra premium.

Scenario 1 — Barbara (Healthy, 4 Doctor Visits/Year)

Barbara (66) visits her primary care doctor twice a year and sees an optometrist twice. Her local Plan G premium is $170/month ($2,040/year), while Plan N is $130/month ($1,560/year) — a $480/year difference. On Plan N, her 4 visits cost $80 in copays. Net annual savings on Plan N: $400 in her pocket.

Barbara chose Plan N because her doctor visit frequency is well below the break-even threshold.

Scenario 2 — George (Managing Rheumatoid Arthritis, 18 Visits/Year)

George (71) requires monthly rheumatology visits, physical therapy, and frequent bloodwork. His annual doctor appointments total 18 visits ($360 in Plan N copays). The Plan G/N premium spread in his area is $30/month ($360/year). Because his copays equal the premium savings, George chose Plan G to avoid copay paperwork and enjoy complete financial peace of mind.

George selected Plan G because high utilization wiped out Plan N's premium savings.

Scenario 3 — Evelyn (Resident of Pennsylvania — Excess Charge Ban State)

Evelyn (65) was worried about Plan N not covering Part B excess charges. When using this tool, she learned that Pennsylvania state law prohibits all excess charges. Knowing her excess charge risk was 0%, she confidently chose Plan N, saving $42/month on premiums ($504/year).

Evelyn used state-specific regulatory protection to maximize her retirement savings safely.

Hypothetical examples for educational purposes. Individual results vary based on location, age, insurer rate filings, and health utilization. Verify quotes at Medicare.gov.

5 Common Plan G vs Plan N Mistakes

Mistake 1 — Overestimating the Risk of Part B Excess Charges

Many seniors pay $400+ extra per year for Plan G solely out of fear of excess charges. In reality, over 97% of doctors accept Medicare assignment, and 8 states ban excess charges outright. You can eliminate excess charges simply by asking your doctor: "Do you accept Medicare assignment?"

Do not choose Plan G based on excess charges alone unless you frequently use non-participating specialists.

Mistake 2 — Forgetting That Neither Plan Covers the Part B Deductible

Some seniors believe Plan G covers 100% of all medical bills starting January 1. Under federal law (MACRA), neither Plan G nor Plan N covers the annual Part B deductible ($283 in 2026). You pay the first $283 out-of-pocket on both plans.

Budget $283 once each calendar year for your Part B deductible regardless of whether you pick Plan G or Plan N.

Mistake 3 — Assuming Plan N Has Provider Network Restrictions

Some seniors confuse Plan N with Medicare Advantage HMOs, thinking Plan N restricts which doctors they can see. Medigap Plan N has NO network restrictions whatsoever and is accepted by every Medicare-contracted doctor in the United States.

Enjoy nationwide provider access with any doctor taking Medicare on both Plan G and Plan N.

Mistake 4 — Failing to Check Future Rate Increase Trajectories

Because Plan G attracts people who expect higher healthcare utilization, its claims loss ratio is often higher than Plan N. Over time, Plan G premiums tend to increase slightly faster than Plan N premiums in many states.

Ask your independent broker or SHIP counselor about the 5-year historical rate increase pattern for both plans in your area.

Mistake 5 — Missing Your Guaranteed Issue Window

You can buy either Plan G or Plan N with zero medical underwriting during your 6-month Medigap Open Enrollment window. If you pick Plan N and later want to upgrade to Plan G, you will likely need to pass medical underwriting in most states.

If you anticipate developing severe chronic conditions requiring frequent procedures, weigh the long-term underwriting barrier.

Official Sources Used in This Tool

All benefit categories, statutory copay maximums, and deductible figures are verified against official CMS publications. Links verified August 15, 2026.

Source Document	Key Regulatory Rule Cited	Verified Date	Official Source Link
CMS — Choosing a Medigap Policy Guide	Standardized Medigap benefit chart (Plans A through N coverage matrix)	August 15, 2026	Medicare.gov Medigap Guide
CMS 2026 Parts A & B Fact Sheet	2026 Part B deductible ($283) and Part A hospital deductible ($1,736)	August 15, 2026	CMS 2026 Parts A & B Fact Sheet
Medicare.gov — Compare Medigap Plan Costs	Official premium search tool by ZIP code and state regulatory rules	Live Tool	Medicare.gov Plan Finder

Frequently Asked Questions

What is the main difference between Medigap Plan G and Plan N?: Both plans cover the 20% Medicare Part B coinsurance and the $1,736 Part A deductible. Plan G covers 100% of all medical bills after you pay the annual $283 Part B deductible. Plan N offers 20–30% lower monthly premiums, but requires up to $20 copays for office visits, $50 for ER visits, and does not cover Part B excess charges.
How do I know if Plan N will save me money over Plan G?: Calculate your annual premium savings (typically $240 to $600/year) and subtract your estimated Plan N copays ($20 per doctor visit and $50 per ER visit). If your annual doctor visit copays are less than your premium savings, Plan N saves you money.
What are Part B excess charges and how common are they?: Part B excess charges occur when a doctor does not accept "Medicare assignment" and legally charges up to 15% above the Medicare-approved amount. According to CMS and KFF data, over 97% of physicians nationwide accept assignment, making excess charges rare. Eight states ban excess charges entirely by law.
Which states prohibit doctors from billing Part B excess charges?: Eight states have passed BALANCE BILLING / MOM (Medicare Overcharge Measure) laws prohibiting doctors from charging Part B excess charges: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In these states, Plan N policyholders face zero excess charge risk.
Do Plan G and Plan N have different doctor networks?: No. Neither Plan G nor Plan N has any network restrictions. As standardized Medigap policies, both plans allow you to see any physician, specialist, or hospital in the United States that accepts Original Medicare. Insurers cannot restrict your provider choices on either plan.
Can I switch from Plan N to Plan G later if my health worsens?: In most states, switching from Plan N to Plan G after your initial 6-month Medigap Open Enrollment window requires medical underwriting. If you develop chronic conditions, insurers can deny your application or charge higher rates. A few states offer annual "birthday rule" or continuous guaranteed issue rights.
Are benefits for Plan G and Plan N identical across all insurance carriers?: Yes. By federal law, every Medigap Plan G offers the exact same government-standardized benefits regardless of which insurance company sells it. The same applies to Plan N. The only differences between carriers are monthly premium pricing, customer service, and annual rate increase history.
Where can I find free, unbiased advice on Medigap options in my state?: Your State Health Insurance Assistance Program (SHIP) provides free, unbiased, state-specific counseling from trained volunteers who do not earn insurance commissions. Find your local SHIP program at shiphelp.org or call 1-877-839-2675.

Related Decision Tools You May Find Useful

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Calculate your 7-month IEP window and check your Medigap open enrollment timing.

Educational Disclaimer

This comparison tool is for educational purposes only. Seniors Audit is not an insurance agency, does not sell insurance, and does not represent any Medicare Supplement insurance company. Medigap plan benefits are standardized by the federal government under the Social Security Act, but monthly premiums vary by carrier, state, age, gender, tobacco use, and rating method (community-rated, issue-age, or attained-age). Always verify specific quotes and underwriting guidelines with insurance companies or at medicare.gov/plan-compare. For free, unbiased, state-specific counseling, contact your local State Health Insurance Assistance Program (SHIP) at shiphelp.org or 1-877-839-2675.