Plan N is the third most popular Medigap plan, covering about 10% of policyholders, or roughly 1.4 million people, according to KFF’s analysis of National Association of Insurance Commissioners data. It exists for one reason: to sell you nearly all of Plan G’s protection for a visibly smaller monthly premium.
The tradeoffs are not vague. They are three specific, countable things, and once you can price them the decision takes about five minutes. Every figure below was pulled on September 6, 2026 from CMS, Medicare.gov and two state insurance department rate filings.
What Plan N Covers and What It Leaves You
Plan N pays 100% of the Part A hospital deductible ($1,736 per benefit period in 2026), Part A coinsurance plus 365 extra hospital days, skilled nursing facility coinsurance ($217 a day for days 21 through 100), Part A hospice coinsurance, the first three pints of blood, and 80% of foreign travel emergency care up to plan limits. On all of that it is identical to Plan G.
It also pays your Part B coinsurance, but with three carve-outs.
1. Office visit copays, up to $20 each. The CMS and NAIC guide Choosing a Medigap Policy states that Plan N pays 100% of the Part B coinsurance except that you must pay a copayment of up to $20 for some office visits. It is a cap, not a flat fee, so a cheap visit costs less than $20.
2. Emergency room copay, up to $50. This applies only to emergency room visits that do not result in an inpatient admission. If you get admitted, the copay does not apply and the visit is handled under your Part A benefits instead.
3. Part B excess charges, uncovered. This one is the sleeper. More on it below.
You also pay the $283 annual Part B deductible yourself in 2026. That is worth saying clearly because it gets miscounted constantly: Plan G does not cover the Part B deductible either. It is not a Plan N disadvantage. Only Plans C and F ever covered it, and both closed to newly eligible beneficiaries on January 1, 2020, which is covered in the Plan F guide.
Part B Excess Charges, Explained Plainly
When a doctor “accepts assignment,” they agree to take the Medicare-approved amount as payment in full. Most do. Medicare.gov states that most doctors, providers and suppliers accept assignment, and providers have a financial reason to: participating providers are paid 5% more than non-participating ones.
A provider who does not accept assignment can bill you more than the approved amount. Medicare.gov says that in many cases the charge cannot be more than 15% above the Medicare-approved amount for non-participating providers, a ceiling called the limiting charge. That 15% slice is the Part B excess charge.
The arithmetic is small on any single service. On a service Medicare approves at $500, the maximum excess charge is $75. It becomes a real number only if you repeatedly see non-participating specialists, or if you need a high-dollar outpatient procedure from one.
Plans F and G pay excess charges in full. Plan N does not, and neither do Plans A, B, D, K, L or M, per the Medicare.gov benefit chart.
Some states take the risk off the table entirely. Ohio is the clearest case, and its ban is statutory rather than a matter of interpretation: Ohio Revised Code 4769.02 states that no health care practitioner, and no person that employs one, shall balance bill for any supplies or service provided to a Medicare beneficiary, with penalties and repayment orders spelled out in section 4769.03.
Two state bans are readable in the primary law itself. Ohio Revised Code 4769.02 says no health care practitioner, and no entity employing one, shall balance bill a Medicare beneficiary. Pennsylvania’s Health Care Practitioners Medicare Fee Control Act (Act 81 of 1990) makes balance billing unlawful in the same flat terms and puts enforcement with the licensing boards.
Beyond those two, a list of eight states circulates widely on consumer and insurer sites: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont. Those sources do not agree with each other on what the protection actually is. Some describe Connecticut’s as limited to low-income beneficiaries in the Qualified Medicare Beneficiary program rather than universal, and several describe New York as capping the excess charge at 5% rather than banning it outright, which is a materially different thing. Protections also generally cover only care you receive inside that state, not care you get while traveling. Treat the circulating eight-state list as a starting point, not a fact, and confirm your own state’s rule with your state insurance department before you let it drive the decision.
What Plan N Costs in 2026
The table below uses filed rates published by the Maryland Insurance Administration as of July 1, 2026, comparing Plan N against Plan G from the same carrier at the same ages, so the only variable is the plan design.
| Age | Plan N monthly | Plan G monthly | Annual premium saved with Plan N | $20 office-visit copays that gap covers |
|---|---|---|---|---|
| 65 | $187 | $249 | $744 | 37 |
| 70 | $236 | $315 | $948 | 47 |
| 75 | $287 | $382 | $1,140 | 57 |
| 80 | $340 | $453 | $1,356 | 67 |
| 85 | $385 | $512 | $1,524 | 76 |
Maryland Insurance Administration filed monthly premiums as of July 1, 2026, CareFirst MedPlus Level 1 male rates for the Baltimore Metro, D.C. Metro and Western Maryland region. The final column divides the annual saving by the $20 office-visit copay cap.
Other carriers price the gap wider. Aetna’s Maryland filing puts Plan N at $194 and Plan G at $300 at age 65, a $106 monthly difference worth $1,272 a year. Mutual of Omaha’s non-tobacco male rate is $197 for Plan N against $278 for Plan G, an $81 gap.
New Jersey’s Division of Aging Services chart, revised January 13, 2026, shows the spread across carriers for a 65-year-old woman: Plan N ran from $105.04 a month at Humana Value to $174.51 at Aetna, with the AARP policy from UnitedHealthcare at $113.53. Across both states, $105 to $200 a month is a fair band for Plan N at 65 as of September 2026.
The Break-Even Math
Here is the whole calculation in three steps.
Step 1. Find your annual premium gap. Take the Plan G quote and the Plan N quote from the same carrier, subtract, and multiply by 12. In the CareFirst example at age 65 that is $744.
Step 2. Estimate your copay exposure. Count your realistic office visits per year and multiply by $20, then add $50 for each emergency room visit you would expect that does not end in admission. Ten office visits and one ER trip is $250.
Step 3. Add an excess-charge allowance. If every provider you see accepts assignment, this is zero. If you live in Ohio, it is zero regardless. If you regularly see specialists who do not accept assignment, budget 15% of what Medicare approves for those services.
In the CareFirst case, a $744 gap against $250 of copays leaves you $494 ahead with Plan N. You would need 37 office visits in a year before the copays alone erase the saving.
The math flips when the gap is thin. If Plan N is only $10 a month cheaper, that is $120 a year, or six office visits. Anyone with a chronic condition and monthly appointments loses on that spread. A useful rule: if the annual premium gap divided by $20 is smaller than the number of office visits you actually make, buy Plan G.
Two more things push the decision toward Plan G regardless of the spread. If a $20 or $50 charge at the counter would make you skip a visit, the copay is not really saving you money. And if you travel often or see out-of-state specialists, your state’s excess-charge protection does not follow you.
Who Plan N Fits
Plan N is a good fit if you are relatively healthy, see a doctor a handful of times a year, live somewhere excess charges are banned or your providers all accept assignment, and you want the lowest sustainable premium without giving up Original Medicare’s freedom to see any doctor who takes Medicare.
It is a poor fit if you have a chronic condition with frequent appointments, if you use the emergency room more than rarely, or if the premium gap in your state is small. In those cases pay for Plan G and stop thinking about it. The direct comparison is in Plan G vs Plan N, and the wider price landscape is in the Medigap cost guide.
If the premium itself is the barrier rather than the plan design, check Medicare Savings Programs first. Qualifying for QMB means your state Medicaid agency pays your Medicare deductibles, coinsurance and copays, which makes a Medigap policy unnecessary. And if you are weighing supplemental coverage against a network plan with an out-of-pocket cap, Medicare Advantage vs Medigap walks through the tradeoff.
Whatever you pick, buy it inside your Medigap open enrollment period, the six months starting when you are 65 and enrolled in Part B. That is the window where insurers cannot underwrite you, and switching later is far harder than most people expect. If a bill does get away from you in the meantime, our guide to negotiating medical bills covers what to ask for.