Plan G and Plan N are the two Medigap plans most brokers are quoting in 2026 for clients new to Medicare. Plan G is the more comprehensive of the two: it covers every Medicare cost-sharing item except the Part B deductible. Plan N covers the same ground but carves out two exceptions: up to $20 copays on office visits, up to $50 copays on ER visits that do not result in hospital admission, and no coverage for Part B excess charges. The question most brokers are actually answering is whether the premium difference between them is worth the coverage gap.
Key Takeaways
- Plan G covers all Medicare cost sharing except the Part B deductible ($257 in 2026). Plan N covers the same items but adds up to $20 office-visit copays, up to $50 ER copays, and does not cover Part B excess charges.
- Plan N typically costs $30 to $80 per month less than Plan G in the same market. At $60 in monthly savings, the client gets $720 per year to offset copays and any excess charge exposure.
- The excess charge gap in Plan N is the central broker concern. In practice, excess charges are rare because over 97 percent of Medicare-participating physicians accept assignment and cannot bill above the approved amount.
- Eight states ban excess charges entirely by statute. In those states, Plan N delivers identical effective coverage to Plan G at a lower premium. Plan G has almost no advantage in those markets.
- High-utilization clients who see specialists frequently in markets with a notable share of non-participating providers are better candidates for Plan G. Low-utilization clients in most markets are better candidates for Plan N.
Side-by-side benefit comparison
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A coinsurance and hospital costs (up to 365 days beyond Medicare) | 100% covered | 100% covered |
| Part A hospice care coinsurance or copay | 100% covered | 100% covered |
| Part A deductible ($1,676 per benefit period in 2026) | 100% covered | 100% covered |
| First 3 pints of blood | 100% covered | 100% covered |
| Skilled nursing facility coinsurance | 100% covered | 100% covered |
| Part B deductible ($257 in 2026) | NOT covered. Client pays once per year. | NOT covered. Client pays once per year. |
| Part B coinsurance or copay (after deductible) | 100% covered | Covered, but client pays up to $20 for office visits |
| Part B excess charges | 100% covered | NOT covered. Client exposed to up to 15% above approved amount. |
| Emergency room copay | 100% covered | Up to $50 copay (waived if admitted as inpatient) |
| Foreign travel emergency (80%, up to plan limits after deductible) | Covered on most Plan G policies | Covered on most Plan N policies |
Illustrative benefit summary. Plan details, premiums, and deductibles vary by carrier, state, and enrollment date. The Part B deductible ($257 in 2026) and Part A deductible ($1,676 per benefit period in 2026) are updated annually by CMS.
The excess charge question in practice
The biggest coverage gap in Plan N is Part B excess charges. A provider who does not accept Medicare assignment can bill up to 15 percent above the Medicare-approved amount for a covered service. Plan G covers that 15 percent. Plan N leaves it as the client's expense.
The counterintuitive fact: excess charges are rare in most US markets because the vast majority of Medicare-participating providers accept assignment. A provider who accepts Medicare assignment is prohibited from billing excess charges. In markets where 97 to 99 percent of physicians accept assignment, the excess charge exposure on Plan N is theoretical rather than practical for most clients.
The situation is different in some urban markets with high concentrations of concierge practices, in certain specialties (dermatology, psychiatry, and some surgical subspecialties), and in states where the Medicare limiting charge has not been universally adopted. A broker in Manhattan is giving different Plan G vs Plan N advice than a broker in suburban Ohio. Local market composition drives the recommendation.
The states where excess charges are banned
Eight states prohibit providers from billing Medicare excess charges by statute: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In these states, a Plan N enrollee faces zero excess charge exposure because providers legally cannot bill it. Plan N delivers identical effective coverage to Plan G in those markets at a lower premium.
For a broker writing Medigap in any of those eight states, the Plan G vs Plan N conversation reduces to: Plan N is cheaper and covers the same events, minus the office-visit and ER copays. The break-even is purely the copay arithmetic.
The total-cost break-even calculation
To illustrate: a 65-year-old in a Texas metro area. Plan G quote: $148 per month. Plan N quote: $108 per month. Premium difference: $40 per month, or $480 per year.
For Plan N to cost more on a total annual basis, the client would need to incur over $480 in out-of-pocket costs. That requires 24 office-visit copays at $20 each, or 12 office visits plus two ER visits that do not result in admission. A client who sees a physician six times per year on average pays $120 in annual copays on Plan N, still $360 below the premium savings.
That pattern holds for most low-to-moderate utilizers. The case for Plan G is made by clients in three situations: heavy specialist use in a market with meaningful excess charge exposure, very high outpatient frequency where monthly copays approach the premium difference, or clients who strongly prefer the simplicity of no copay at the point of service and are willing to pay for it.
What Plan F was and why it matters to clients over 65
Plan F was the Medigap plan that also covered the Part B deductible, which Plan G does not. CMS closed Plan F to new enrollees on January 1, 2020, for clients who became eligible for Medicare on or after that date. Clients who were eligible for Medicare before January 1, 2020, can still purchase Plan F if a carrier offers it. Brokers who have pre-2020 clients still on Plan F should note that Plan F pools have been aging without new entrants for over six years, which can drive premium increases faster than the broader Medigap market as the pool skews older and sicker.
For pre-2020 clients evaluating a switch from Plan F, the calculation is: Plan F premium minus the Part B deductible ($257) versus Plan G premium or Plan N premium. If Plan G costs $257 per year less than Plan F, the client breaks even by paying the deductible directly. Many Plan F clients find Plan G is the lower net cost by a meaningful margin, and the underwriting rules for switching may apply depending on state and circumstances. For the full mechanics of guaranteed-issue rights, read Medigap guaranteed issue rights and the 6-month open enrollment window.
For clients who travel frequently or split time between states, the Medigap vs Medicare Advantage comparison has an additional dimension. Medigap plans, including Plan G and Plan N, are accepted by any Medicare-participating provider nationwide, which is a material advantage over network-based Medicare Advantage plans for clients who spend significant time out of their home state. For more on that comparison, read Medicare Advantage vs Medigap for clients who travel or split time between states.
FAQ
The most common questions brokers and clients ask when comparing Medigap Plan G and Plan N.
What are Part B excess charges and how often do they actually happen?
Part B excess charges occur when a provider does not accept Medicare assignment and bills more than the Medicare-approved amount for a service. Under federal law, providers who do not accept assignment can charge up to 15 percent above the Medicare-approved amount (or the Medicare limiting charge, whichever is lower). Nationally, over 97 percent of Medicare-participating physicians accept assignment, making excess charge exposure rare for most clients. However, certain specialties in specific markets, such as psychiatry, dermatology, and some surgical subspecialties in urban markets with high concentrations of concierge or cash-pay practices, have lower assignment acceptance rates. Brokers should check assignment acceptance rates in the client's local market before recommending Plan N in those cases.
Can a Plan N enrollee switch to Plan G later if their health changes?
In most states, switching from Plan N to Plan G outside of a guaranteed-issue window requires answering health underwriting questions, and the insurer can decline or surcharge based on health history. Most Medigap policies are issued during the 6-month open enrollment period that begins at age 65 when the beneficiary enrolls in Part B. After that window closes, insurers in most states can apply medical underwriting. The exceptions are guaranteed-issue rights triggered by events such as losing employer coverage or a plan leaving the market. In states with birthday rules (California, Illinois, Nevada, and others), clients have a window each year to switch Medigap plans within the same coverage level without medical underwriting. Brokers should confirm the applicable state rules before counseling a client on switching.
Is Plan G always the better choice for high-utilization clients?
Not necessarily. The correct analysis compares total annual cost, not just coverage breadth. A high-utilization client who sees a physician 12 times per year on Plan N pays up to $240 in office-visit copays (12 visits at $20 each). If Plan N costs $60 per month less than Plan G, that is $720 in annual premium savings against $240 in maximum copays, leaving $480 in net savings for the client. Plan G is the better choice only if the client's expected copays and excess charge exposure exceed the premium difference. For clients who see specialists in markets with lower assignment acceptance rates, or who have specialist relationships with providers who do not accept assignment, Plan G provides cleaner cost certainty. For most outpatient-heavy clients in high-assignment markets, Plan N still wins on total cost.
Does the Plan N ER copay apply even if the visit leads to inpatient admission?
No. The Plan N emergency room copay of up to $50 is waived if the visit results in a Medicare-covered inpatient hospital admission. The client pays the copay only for ER visits that do not result in inpatient admission. This is a meaningful protection for clients who use the ER for genuinely emergent conditions that require hospitalization. The copay applies to observation stays that are not classified as inpatient, which is a separate and ongoing issue in Medicare policy. Brokers should note that an ER visit followed by observation-status time rather than inpatient admission does not waive the Plan N copay because CMS does not classify observation as inpatient.
How does Medigap Plan G compare to Plan G-HD (high deductible)?
Plan G-HD is a variation of Plan G with a high deductible of $2,870 in 2026. Below that deductible, the client pays all Medicare cost sharing out of pocket. Once the deductible is met, Plan G-HD covers cost sharing identically to standard Plan G, including excess charges. Plan G-HD premiums are substantially lower than standard Plan G, often by $100 to $150 per month, making it an option for healthy, low-utilization clients who are comfortable accepting the deductible risk. The decision between standard Plan G, Plan G-HD, and Plan N is the same total-cost exercise: expected annual utilization against the premium difference and the deductible exposure.
