Medigap Plan G vs Plan N: Complete Comparison

Here's the real question you're trying to answer: is the monthly premium difference between Plan G and Plan N worth it?

And the honest answer is: it depends on how much you use healthcare. Which is a frustrating answer, I know. But the math is actually not that complicated once you run the numbers for your specific situation, and that's exactly what this article does.

Plan G and Plan N both cover the major stuff. Hospital deductibles? Covered. Coinsurance? Covered. Skilled nursing facility stays? Covered. Foreign travel emergency? Covered. They share the same foundation. The differences are in the details—and in markets where the premium gap is significant, those details matter a lot.

The population that buys Medigap tends to skew toward Plan G because agents push it, because predictability has real psychological value, and because the people who are most health-anxious (and therefore motivated to buy Medigap at all) want zero uncertainty about their bills. But Plan N is genuinely the better financial choice for a meaningful segment of Medicare beneficiaries, and it doesn't get enough honest attention.

Let me put this as plainly as possible.

Both Plan G and Plan N cover: — Medicare Part A deductible ($1,676 in 2026) — Part A coinsurance and hospital costs up to 365 additional days after Medicare stops paying — Skilled nursing facility coinsurance (days 21–100) — Part A hospice care coinsurance — First three pints of blood — Foreign travel emergency (80% after $250 deductible, up to $50,000 lifetime)

Neither Plan G nor Plan N covers: — Medicare Part B deductible ($283 in 2026) — Prescription drugs (need separate Part D) — Dental, vision, hearing — Long-term custodial care

Here is where they diverge:

Part B Coinsurance: — Plan G: Covered 100%. Zero out-of-pocket after your Part B deductible. — Plan N: Covered with exceptions. Up to $20 copay for office visits. Up to $50 copay for emergency room visits that don't result in inpatient admission. All other Part B coinsurance covered.

Medicare Part B Excess Charges: — Plan G: Covered. If a doctor charges up to 15% above Medicare's approved amount, Plan G pays it. — Plan N: Not covered. Excess charges are your responsibility.

That's the whole difference. Copays on visits and no excess charge coverage on Plan N, versus none of that with Plan G. The premium reflects this gap.

The gap between Plan G and Plan N premiums is real and consistent. Across most markets, Plan N runs 20–30% less than Plan G. Let's put real numbers on this.

Age 65, Female, Non-Smoker, same carrier:

Atlanta, GA: — Plan G (Cigna): $131/month → $1,572/year — Plan N (Cigna): $93/month → $1,116/year — Annual savings with Plan N: $456

Dallas, TX: — Plan G: $142/month → $1,704/year — Plan N: $104/month → $1,248/year — Annual savings with Plan N: $456

Tampa, FL: — Plan G: $168/month → $2,016/year — Plan N: $122/month → $1,464/year — Annual savings with Plan N: $552

Chicago, IL: — Plan G: $152/month → $1,824/year — Plan N: $113/month → $1,356/year — Annual savings with Plan N: $468

Age 70, same markets, premiums scale up roughly 20–25% but the gap proportionally stays similar. The absolute dollar difference in most markets at age 65 lands between $400 and $600/year.

At age 75, the premium gap often widens slightly in absolute terms—Plan G might cost $230/month versus Plan N at $165, a $65/month or $780/year difference. This matters because your healthcare utilization is also typically rising at 75, which partly offsets the savings.

For a healthy person who enrolls in Plan N at 65 and stays with it, the cumulative premium savings over 10 years could easily be $5,000–$8,000 in nominal terms (before factoring in out-of-pocket costs from copays). The question is whether the copays and potential excess charges eat that up.

Let's run three actual scenarios to see which plan makes financial sense.

Scenario 1: The Active Healthy Retiree Meet Barbara, 65, retired teacher in Tennessee. She's in good health. Annual healthcare pattern: one primary care visit in January ($20 copay under Plan N), one dermatology checkup in spring ($20 copay), one minor urgent care visit in fall ($20 copay or $50 if ER). She occasionally needs a specialist but manages conditions well. No hospitalizations.

Plan G costs: $155/month premium + $283 Part B deductible = $2,143/year total Plan N costs: $115/month premium + $283 deductible + $60 in copays (3 office visits × $20) = $1,723/year total

Plan N saves Barbara $420/year. Over 5 years, she's ahead by $2,100. The copays are trivially small relative to the premium savings. Barbara should buy Plan N.

Scenario 2: The Moderate Utilizer Meet Gerald, 68, retired engineer in Ohio with well-managed Type 2 diabetes and mild hypertension. He sees his primary care doctor quarterly (4 visits/year), his endocrinologist twice a year, and his cardiologist once a year. Total: 7 office visits per year. He has one ER visit after chest pain that turns out to be GERD—no admission.

Plan G costs: $205/month premium + $283 deductible = $2,743/year Plan N costs: $148/month premium + $283 deductible + $140 in copays (7 office visits × $20) + $50 ER copay = $2,263/year

Plan N still saves Gerald $480/year. The copays add up but they don't eat the premium savings. Also note: Gerald's doctors are all Medicare-participating so no excess charges. Plan N works here.

But—and this matters—if Gerald's endocrinologist doesn't accept Medicare assignment and charges a 10% excess on a $500 procedure, that's an additional $50 out of pocket that Plan G would have covered. These incidents add up marginally but don't typically change the overall math unless they're very frequent.

Scenario 3: The High Utilizer Meet Carol, 71, retired nurse in Florida managing COPD and degenerative joint disease. She sees her pulmonologist monthly (12 visits/year), her rheumatologist quarterly (4 visits/year), and her primary care doctor quarterly (4 visits/year). That's 20 office visits annually. She also had one ER visit that didn't result in admission.

Plan G costs: $260/month premium + $283 deductible = $3,403/year Plan N costs: $185/month premium + $283 deductible + $400 in copays (20 visits × $20) + $50 ER = $2,943/year

Plan N still saves Carol $460/year. Even with 20 office visits, the premium difference usually still wins. But—here's the thing—Carol is on the edge. If she has any providers who balance bill (excess charges), if her visits go above 20 per year, if she lands in the ER a second time that doesn't result in admission ($50 more), she starts to approach break-even.

At some point in the high-utilization range, Plan G offers cleaner peace of mind at a relatively small absolute premium difference. The tipping point is usually north of 25 office visits per year AND regular exposure to excess charges.

The Excess Charge Variable The excess charge issue is Plan N's real wild card. Medicare non-participating physicians can legally charge up to 15% above Medicare's approved rate. In some markets—particularly parts of New York, Massachusetts, Minnesota, and areas with large academic medical centers—excess charges are common. In rural areas and markets where virtually all physicians participate in Medicare, excess charges are rare.

If you're in a market with frequent excess charges and you see specialists regularly, this tilts toward Plan G. If you're in a market where excess charges are uncommon (check your state—some ban excess charges entirely: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont), Plan N's lack of excess charge coverage is a non-issue.

This is a crucial piece of the G vs N decision that most articles bury or skip.

States that prohibit Medicare excess charges (all providers must accept Medicare assignment as payment in full): — Connecticut — Massachusetts — Minnesota — New York — Ohio — Pennsylvania — Rhode Island — Vermont

If you live in any of these states, the 'Plan G covers excess charges, Plan N doesn't' distinction is irrelevant. In these markets, Plan G and Plan N differ only in the copay structure. The premium savings from Plan N become even more attractive when you remove the excess charge risk entirely.

For everyone else, the practical risk of excess charges varies. Ask your current doctors if they accept Medicare assignment—this is a yes or no question you can ask any provider's billing office. If all your regular providers accept assignment, you're only exposed to excess charges from new or emergency providers you haven't vetted. That risk exists but is manageable.

After running this math with hundreds of beneficiaries, here's the honest recommendation:

Buy Plan N if: — You're 65–72, in good health, and see 10 or fewer providers per year — You live in a state that bans excess charges — You're comfortable with the $20 office visit copay and $50 ER copay — You have a small emergency fund to cover potential copays — Premium savings matter to you because you're on a budget

Buy Plan G if: — You see doctors frequently (15+ visits/year) due to chronic conditions — You live in an area with high rates of non-participating physicians — You want absolute predictability with no copay-related math — You're older (75+) where the utilization risk is harder to predict — The premium difference is less than $400/year in your market (sometimes the gap is small) — You have anxiety about unexpected bills and the peace of mind is genuinely worth the premium to you

Here's what I keep coming back to: for a healthy 65-year-old in most markets, Plan N saves real money and the copays are trivial. The standard advice to default to Plan G is partially driven by agent commissions (higher premium = higher commission) and partially by risk aversion that's not always calibrated to the actual math.

But Plan G is absolutely the right call for people who are already managing multiple conditions, who see doctors frequently, and who live in markets with common excess charges. It's not a bad plan—it's a great plan. It just isn't always the cheapest path to the same outcome.

And if you're completely unsure, pick Plan G during your open enrollment period. You can potentially switch to Plan N later if you want to reduce premiums and pass underwriting—but you cannot get back to Plan G without underwriting if you've developed health issues. When in doubt, the safer door is Plan G.