Medigap plans are standardized by federal law, which means a Plan G from one insurer covers exactly what a Plan G from another insurer covers. Price is the only difference between two policies carrying the same letter. That makes the Plan G versus Plan N question unusually clean: you are comparing two known benefit packages, not two marketing pitches.
The plans differ in exactly three places. Everything else on the chart is identical, including the Part A deductible, the 365 extra hospital days, skilled nursing coinsurance, hospice coinsurance, the blood benefit, and 80% foreign travel emergency coverage. Every figure below was pulled from CMS, Medicare.gov, the Maryland Insurance Administration and the Nevada Division of Insurance on September 6, 2026.
The Only Three Differences
1. Plan N charges copays at the point of service. CMS states it this way in the 2026 edition of Choosing a Medigap Policy: Plan N pays 100% of the Part B coinsurance, but you pay a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in an inpatient admission. That ER waiver matters. If you go to the emergency room and get admitted, the $50 disappears and Plan N behaves like Plan G for that episode.
Note the words “up to.” The copay stands in for the 20% Part B coinsurance, so on a low-cost visit your share is the coinsurance, not a flat $20. That makes the break-even math below conservative in Plan N’s favor.
2. Plan G covers Part B excess charges and Plan N does not. This is the only benefit line where Plan G is genuinely more complete. More on the size of that exposure below.
3. Plan N costs less. How much less depends entirely on your state, your insurer and your age.
Both plans leave you the annual Part B deductible, which CMS set at $283 for 2026, up from $257. Neither plan can cover it. Under the 2015 MACRA law, plans that cover the Part B deductible (C and F) cannot be sold to anyone who became eligible for Medicare on or after January 1, 2020.
Plan G vs Plan N Side by Side
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A coinsurance plus 365 extra hospital days | 100% | 100% |
| Part A deductible ($1,736 per benefit period in 2026) | 100% | 100% |
| Part B coinsurance | 100% | 100%, minus copays |
| Office visit copay | None | Up to $20 |
| Emergency room copay | None | Up to $50, waived if admitted |
| Part B excess charges | 100% | Not covered |
| Part B deductible ($283 in 2026) | Not covered | Not covered |
| Skilled nursing facility coinsurance | 100% | 100% |
| Hospice coinsurance, blood (first 3 pints) | 100% | 100% |
| Foreign travel emergency | 80% to plan limits | 80% to plan limits |
| Typical monthly premium at 65 | Higher | $38 to $62 lower in the filings below |
The Break-Even Math, With Real Rates
The question is simple arithmetic: the premium you save on Plan N buys you a certain number of $20 copays before Plan N stops being the cheaper plan.
Example 1, Nevada. The Nevada Division of Insurance publishes annual premiums for a 65-year-old female non-smoker in Las Vegas ZIP 89102. In its 2026 guide, Cigna’s Plan G is $1,916 a year and its Plan N is $1,461 a year.
- Premium saving: $1,916 minus $1,461 equals $455 a year, or about $37.92 a month.
- Copays that $455 buys: $455 divided by $20 equals 22.75.
- Break-even: about 23 office visits in a year.
Example 2, Maryland. The Maryland Insurance Administration publishes monthly premiums as of July 1, 2026. CareFirst MedPlus quotes a 65-year-old male in the Baltimore Metro region $249 a month for Plan G and $187 a month for Plan N at its guaranteed issue rate.
- Premium saving: $62 a month, or $744 a year.
- Copays that $744 buys: $744 divided by $20 equals 37.2.
- Break-even: about 38 office visits in a year.
Federal Life, also in the Maryland guide, quotes a 65-year-old male non-tobacco $230 for Plan G and $166 for Plan N, a $64 monthly gap and a break-even around 38 visits.
Twenty-three to thirty-eight doctor visits a year is a lot of doctor visits. For most people the honest read is that Plan N wins on total cost, and it is not close.
The exception that proves the rule. In the same Nevada guide, Humana quotes Plan G at $1,888 a year and Plan N at $1,852, a gap of $36 for the entire year. Two office visits erase it. If your best available Plan N is priced within a few dollars a month of your best available Plan G, Plan N is pointless. This is why you compare the same letter across insurers before you compare letters. Our Medigap cost guide walks through how rating method (community, issue age, attained age) changes what these numbers look like at 75 and 80, and the Plan G and Plan N cost pages go deeper on each one.
Part B Excess Charges: Smaller Than Advertised
This is the benefit Plan G has and Plan N does not, and it is routinely oversold.
Most doctors accept assignment, meaning they take Medicare’s approved amount as payment in full. A provider who has not signed a participation agreement is “non-participating” and can bill above it. Medicare.gov puts the cap this way: in many cases the charge cannot be more than 15% above the Medicare-approved amount, called the limiting charge.
The 15% is applied to a smaller base, though, and CMS spells out the arithmetic on its Physician Fee Schedule documentation page. The limiting charge is 115% of the payment amount for a non-participating physician, and the law sets that at 95% of the participating fee schedule amount. Multiply 1.15 by 0.95 and you get 1.0925. So the limiting charge is 109.25% of the standard fee schedule amount, and the excess you can be billed is about 9.25% of it, not 15%.
On a service with a $200 fee schedule amount, the limiting charge is $218.50. Plan G pays that $18.50. Plan N leaves it to you.
Two things shrink the exposure further. First, the limiting charge does not apply to durable medical equipment, and CMS lists the services it does apply to (physician services, diagnostic tests, outpatient PT and OT from independent practitioners, radiation therapy, and incident-to services). Second, some states have banned the practice outright. Ohio Revised Code 4769.02 is one sentence long: no health care practitioner, and no person that employs one, shall balance bill for any supplies or service provided to a Medicare beneficiary.
Lists of “the eight states that ban excess charges” circulate widely online. The statutes differ in scope, some cover only certain beneficiaries, and we could verify only a few of them directly against state law as of September 2026. Do not assume you are protected. Call your State Insurance Department and ask whether providers in your state may balance bill Medicare beneficiaries, because the answer changes the value of Plan G’s excess charge benefit to roughly zero.
Who Should Take Plan N
Take Plan N if the premium gap in your state is real (say $30 a month or more), you see a doctor a normal number of times a year, and either your state bans excess charges or the providers you use accept assignment. You can check that last one before you enroll: Medicare’s care compare tool flags whether a provider accepts assignment.
Take Plan G if you have a chronic condition that puts you in specialist offices monthly, if you travel and see unfamiliar providers, if a $20 surprise at the desk would genuinely bother you, or if your local Plan N is priced within a few dollars of Plan G.
One thing that should not drive the decision is the idea that you can start on N and move to G if your health changes. There is no annual open enrollment period for Medigap. Your right to buy any plan at the best rate is a one-time six-month window that opens the first month you are both 65 and enrolled in Part B. After that, most states let insurers medically underwrite you. Pick the plan you want to keep.
The Bottom Line
Plan G and Plan N are the same policy with two adjustments: N adds capped copays and drops the excess charge benefit, and N charges less for the trade. In the state rate filings we read for 2026, that trade was worth $455 to $768 a year, against copay exposure that would require 23 to 38 office visits to consume.
Run the same three-line calculation on the actual quotes in front of you. Premium gap times 12, divided by 20, equals the number of visits at which the plans tie. If that number is larger than your realistic year, Plan N is the cheaper plan. If your state permits excess charges and you use non-participating specialists, add roughly 9% of their fee schedule amounts to Plan N’s side of the ledger before you decide. And if you are still choosing between Medigap and a Medicare Advantage plan in the first place, that is a different and much larger decision, covered in Medicare Advantage vs Medigap. Whichever letter you pick, an excess charge or a copay you were not expecting is still negotiable, and our guide to negotiating medical bills covers the script.