Medigap Plan G vs Plan N: The Real Difference Isn't the Copays
Plan G and Plan N share every benefit except two. Plan N's copays are small and capped. Its gap on Part B excess charges has no cap and matters more in some states than others.
Plan G and Plan N cover the same things with two exceptions. Plan N has a copay of up to $20 for some office visits and up to $50 for an ER visit that does not lead to admission. Plan G pays those in full. Plan G also covers Part B excess charges, the amount up to 15% above the Medicare-approved rate that a provider who does not accept Medicare assignment may bill. Plan N does not. The copays are capped per visit and add up slowly. Excess charges have no cap, and whether they can be billed depends on your state.
Our Medigap Plan Comparison Tool shows all 10 standardized plans. G and N are the two most often chosen by people new to Medicare. This article works through both differences with numbers.
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A coinsurance and 365 extra hospital days | 100% | 100% |
| Part A deductible | 100% | 100% |
| Skilled nursing facility coinsurance | 100% | 100% |
| Part A hospice coinsurance, first 3 pints of blood | 100% | 100% |
| Part B deductible ($283 in 2026) | Not covered | Not covered |
| Part B coinsurance | 100% | 100%, less copays of up to $20 (office) and $50 (ER, not admitted) |
| Part B excess charges | 100% | Not covered |
| Foreign travel emergency | 80% after $250 deductible | 80% after $250 deductible |
What's identical between the two plans
Both plans pay Part A coinsurance and up to 365 extra hospital days, the first 3 pints of blood, Part A hospice coinsurance, skilled nursing facility coinsurance and the Part A deductible. Both leave you to pay the annual Part B deductible, $283 in 2026. Both cover foreign travel emergency care at 80% after a $250 deductible, up to the plan's lifetime limit. That leaves two differences.
Difference #1: the copays
Plan N pays your Part B coinsurance except for a copay of up to $20 for some office visits and up to $50 for an ER visit that does not end in an inpatient admission. The copay is a flat amount, so the worst case is easy to estimate. Someone who sees a doctor twice a month, 24 visits a year, pays at most $480 in office copays.
Pricing surveys commonly put Plan N's premium at roughly $40 to $80 a month below Plan G's for the same age, insurer and location. Actual premiums vary by carrier, state, age and tobacco use, so get quotes for both.
| Premium gap | Plan N saves per year | Office visits before copays cancel the saving |
|---|---|---|
| $40 a month | $480 | 24 |
| $60 a month | $720 | 36 |
| $80 a month | $960 | 48 |
Few people see a doctor 24 or more times a year. On copays alone, Plan N comes out ahead for most people.
Plan N Copays
Up to $20 per office visit, up to $50 per non-admitted ER visit. Capped per visit, not a percentage of the bill.
Typical Premium Gap
Commonly quoted at roughly $40-$80 a month less for Plan N than Plan G. Varies by carrier, state, age and tobacco use.
Part B Excess Charges
Up to 15% above the Medicare-approved rate. Plan G covers this in full; Plan N covers none of it.
States Restricting Excess Charges
Most commonly cited: CT, MA, MN, NY, OH, PA, RI, VT. The strength of the protection differs from state to state.
Difference #2: Part B excess charges
Most doctors accept Medicare assignment, which means they take the Medicare-approved amount as full payment. A provider who does not accept assignment may bill up to 15% above the approved rate. That extra amount is the Part B excess charge. Plan G pays it. Plan N does not, so you pay it yourself.
An excess charge grows with the bill. On a $200 office visit it is up to $30. On $3,000 of approved charges for a procedure it is up to $450. There is no yearly limit. One large bill from a provider who does not accept assignment can cost more than a year of Plan N's premium savings.
Where you live affects the risk. Eight states are commonly cited as restricting excess charges, and the protection is not equal among them:
- Broad prohibitions: Massachusetts, Minnesota, Ohio and Pennsylvania block excess charges in most ordinary situations.
- Narrower rules with exceptions: Connecticut, New York, Rhode Island and Vermont. New York, for example, still allows providers to bill up to 5% above the Medicare-approved amount.
In the other 40 or so states, a provider who does not accept assignment can bill the full 15%, and a Plan N member pays all of it.
Which one to choose
Plan N suits most people. The copays are small and capped, and the premium saving usually exceeds them.
Plan G makes more sense if you live in a state with no restriction on excess charges and you are likely to see providers who do not accept assignment. That is more likely if you travel often, see many specialists, or live where few providers take assignment.
Before you decide:
- Ask each of your doctors, "Do you accept Medicare assignment?" If all of them do, the excess charge gap does not affect you with those doctors.
- Get quotes for both plans from the same insurers and work out the yearly premium difference.
- Ask how each insurer has raised rates in recent years.
Choose carefully the first time. In most states, switching Medigap plans after your initial enrollment window means answering health questions, and the insurer can decline you or charge more. A SHIP counselor can compare real quotes with you for free through our SHIP Counselor Locator.
Frequently Asked Questions
What's the actual difference between Medigap Plan G and Plan N?
Two things. Plan N has a copay of up to $20 for some office visits and up to $50 for ER visits that do not lead to admission, and Plan G pays those in full. Plan G covers Part B excess charges, the amount a provider who does not accept Medicare assignment can bill above the Medicare-approved rate, and Plan N does not. All other benefits are the same.
How much can Plan N's copays actually add up to in a year?
Usually a few hundred dollars at most, because the copay is capped per visit: up to $20 for an office visit and up to $50 for an ER visit without admission. For most people, Plan N's lower premium saves more than the copays cost.
What are Medicare Part B excess charges, and does Plan N cover them?
A Part B excess charge is the extra amount, up to 15% above the Medicare-approved rate, that a provider who does not accept Medicare assignment may bill. Plan G pays it in full. Plan N does not, so the member pays it. This cost has no cap under the plan.
Which states don't allow Medicare Part B excess charges?
Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont are the states most commonly cited as restricting them. Massachusetts, Minnesota, Ohio and Pennsylvania have broad prohibitions. Connecticut, New York, Rhode Island and Vermont have narrower rules with exceptions. New York, for example, still allows billing up to 5% above the Medicare-approved amount. In the other 40 or so states, providers who do not accept assignment can bill up to the full 15%.
Is Plan N or Plan G cheaper overall?
Plan N usually costs less overall for people whose providers accept Medicare assignment, because its lower premium outweighs the capped copays. Plan G can cost less for people in a state without excess charge protections who see providers that do not accept assignment, because one excess charge bill has no cap. The answer depends on where you live and which providers you use.
This article explains federally standardized Medigap benefits and 2026 cost-sharing figures as of October 2026. It is not insurance advice and does not estimate premium quotes, which vary by insurance company, age, gender, tobacco use and location. For free one-on-one help comparing Medigap quotes, contact your State Health Insurance Assistance Program (SHIP).