Two Medigap plans dominate the market for new Medicare beneficiaries, and choosing between them is one of the most consequential financial decisions you will make in retirement. The Medicare Plan N vs Plan G debate comes down to a straightforward tradeoff: lower premiums with modest copays versus higher premiums with virtually zero out-of-pocket costs at the point of care. Understanding exactly how these plans differ will help you pick the option that aligns with your health, budget, and risk tolerance.
Coverage Comparison at a Glance
Both Plan G and Plan N cover the Part A deductible ($1,632 in 2025), Part A coinsurance and hospital costs, skilled nursing facility coinsurance, Part B coinsurance (with a caveat for Plan N), the first three pints of blood, and Part A hospice care coinsurance. Both plans also include 80 percent coverage for foreign travel emergencies up to the plan lifetime limit.
The differences are narrow but meaningful. Plan G covers the Part B coinsurance in full and also pays Part B excess charges, which are amounts billed above the Medicare-approved rate by providers who do not accept assignment. Plan N covers the Part B coinsurance as well, but it requires a copay of up to $20 for some office visits and up to $50 for emergency room visits that do not result in an inpatient admission. Plan N does not cover Part B excess charges at all.
Neither plan covers the annual Part B deductible ($257 in 2025). Both require you to pay that amount before Medigap coverage applies to Part B services.
Monthly Premium Differences
The premium gap between these two plans is the core of the Medicare Plan N vs Plan G decision. Nationally, Plan N premiums tend to run $25 to $60 per month less than Plan G premiums from the same insurer in the same ZIP code. For a 65-year-old nonsmoker, Plan G premiums typically range from $120 to $280 per month, while Plan N premiums range from $90 to $210 per month.
That translates to annual savings of roughly $300 to $720 by choosing Plan N. Whether those savings offset the copays and excess charge exposure depends on how often you visit the doctor and whether your providers accept Medicare assignment.
Understanding Part B Excess Charges
Part B excess charges occur when a provider bills up to 15 percent above the Medicare-approved amount. Only providers who accept Medicare but do not accept assignment can charge this extra amount. According to CMS data, fewer than 1 percent of Medicare claims involve excess charges, and the average excess charge per claim is modest.
However, for beneficiaries who see specialists in high-cost areas or who use out-of-state providers, excess charges can add up. If your doctors all accept Medicare assignment, which the vast majority do, this difference between Plan G and Plan N has no practical impact on your wallet. You can verify whether your providers accept assignment by searching the Medicare.gov provider directory.
When Plan G Makes More Sense
Plan G is the better choice if you want the simplest possible coverage with no copays and no risk of excess charges. It is particularly well suited for beneficiaries who see multiple specialists, have chronic conditions requiring frequent office visits, or travel often and may need to see unfamiliar providers. With Plan G, your only annual out-of-pocket cost for Medicare-covered services is the $257 Part B deductible.
Plan G also appeals to beneficiaries who value predictability. You know exactly what your healthcare will cost each year: the Part B deductible plus your monthly premiums. There are no surprises at the doctor’s office and no bills arriving weeks later for excess charges. For a deeper look at this plan, read our Medicare Supplement Plan G guide.
When Plan N Makes More Sense
Plan N is the smarter pick if you are relatively healthy, visit the doctor infrequently, and want to keep premiums as low as possible while still maintaining strong coverage. The copay structure is modest: up to $20 per office visit and up to $50 for non-admitted ER visits. If you go to the doctor four times a year, your total copay exposure is roughly $80, far less than the $300 to $720 you save on premiums.
Plan N is also a strong choice if all of your providers accept Medicare assignment, which eliminates the excess charge concern entirely. According to KFF, more than 98 percent of non-pediatric physicians participate in Medicare, and most of those accept assignment. In states that prohibit excess charges altogether, such as Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, the gap between Plan N and Plan G narrows further.
Running the Numbers: A Real-World Example
Consider a 67-year-old woman in Ohio who visits her primary care doctor six times per year and sees one specialist twice per year. Her Plan G premium is $175 per month. Her Plan N premium from the same insurer is $135 per month.
With Plan G, her annual cost is $175 x 12 plus the $257 Part B deductible, totaling $2,357. With Plan N, her annual cost is $135 x 12 plus the $257 Part B deductible plus up to $160 in office visit copays (8 visits x $20), totaling $2,037. In this scenario, Plan N saves her $320 per year. Over a 20-year retirement, that difference compounds to $6,400 or more, assuming consistent savings.
This example illustrates why the Medicare Plan N vs Plan G comparison favors Plan N for beneficiaries with moderate healthcare usage and assignment-accepting providers. However, if this same person had 15 or more office visits per year or saw providers who charge excess fees, the math could tilt toward Plan G.
Switching Between Plans
If you start with one plan and later decide the other would serve you better, you can apply to switch. However, outside of your initial Medigap Open Enrollment Period, insurers in most states can require medical underwriting. States with birthday rules, such as California and Oregon, give you guaranteed-issue rights to switch to a plan with equal or lesser benefits during your birthday month each year. Since Plan N covers less than Plan G, switching from Plan G to Plan N under a birthday rule is typically straightforward.
Switching from Plan N to Plan G outside of open enrollment may require passing medical underwriting. If you are considering this move, apply before any new health conditions develop. For more on enrollment timing, see our Medicare Enrollment 2025 Guide.
Frequently Asked Questions
Does Plan N cover preventive care visits without a copay?
Yes. Medicare-covered preventive services, such as annual wellness visits and certain screenings, are covered at 100 percent by Original Medicare with no coinsurance. Because there is no coinsurance for these visits, Plan N’s copay provision does not apply. You pay nothing for covered preventive care under either Plan G or Plan N.
Which plan has lower rate increases over time?
Rate increase trends depend on the insurer and state rather than the plan letter itself. However, Plan N pools tend to attract younger, healthier enrollees, which can result in slower premium growth over time compared to Plan G pools. This is not guaranteed, but it is a pattern observed in several state rate filings reviewed by the NAIC.
Can I have prescription drug coverage with either plan?
Neither Plan G nor Plan N includes prescription drug coverage. You need a separate Medicare Part D plan for medications. Learn about Part D costs in our Medicare Part D donut hole guide.
What if I rarely go to the doctor?
If you visit the doctor only once or twice a year, Plan N is almost certainly the more economical choice. Your copay exposure would be $20 to $40 annually, while your premium savings could exceed $300. Some very healthy beneficiaries also consider high-deductible Plan G or Plan K for even lower premiums. Compare all options in our Compare Medicare Supplement Plans Guide.
Bottom Line
Plan G delivers maximum peace of mind with the least out-of-pocket exposure at the point of care. Plan N delivers strong coverage at a noticeably lower premium, with modest copays that most beneficiaries find manageable. Run the math based on your own visit frequency, provider assignment status, and local premium quotes. If the annual premium savings from Plan N exceed your expected copays and excess charge risk, Plan N is the better financial choice. If you prefer zero-surprise billing and see providers who may not accept assignment, Plan G earns its higher premium. For broader plan comparisons, visit our Medigap plans overview and our healthcare policy guide.