Understanding Medigap Plan G vs Plan N Basics
Medigap Plan G and Plan N are two of the most popular Medicare Supplement options for people enrolled in Original Medicare (Part A and Part B). Both plans are designed to help pay some or most of the costs that Original Medicare leaves for you to pay out of pocket.
Medigap plans are standardized by letter (A, B, C, D, F, G, K, L, M, N). That means a Plan G from one company must provide the same basic benefits as a Plan G from any other company in your state. However, premiums, underwriting rules, and extra perks can vary by carrier and location.
The main differences between Plan G and Plan N are:
- How much you pay in monthly premiums
- Which cost-sharing items you are responsible for (like copays and excess charges)
- How predictable your out-of-pocket costs are from year to year
Both Plan G and Plan N are available to people who became Medicare-eligible after January 1, 2020, unlike Plan F, which is closed to newer beneficiaries.
How Out-of-Pocket Costs Work with Original Medicare
To compare Plan G and Plan N, you first need to understand what costs Original Medicare leaves you to pay.
Key Medicare terms in plain language
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care (limited), some home health, and hospice.
- Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health.
The main out-of-pocket costs with Original Medicare are:
- Deductibles: A set amount you pay each benefit period or year before Medicare pays.
- Coinsurance: A percentage of the bill you pay after Medicare pays its share.
- Copays: Fixed dollar amounts for certain services (more common in Medicare Advantage than in Original Medicare, but Plan N introduces some copays).
- Excess charges: Extra amounts a provider can bill above the Medicare-approved amount, up to 15%, if they do not accept Medicare “assignment.”
Original Medicare cost gaps Medigap can help with
Under Original Medicare alone (no Medigap):
- You face a Part A hospital deductible per benefit period (not once per year).
- You pay daily hospital coinsurance for long stays.
- You pay 20% coinsurance for most Part B services after meeting the annual Part B deductible.
- There is no out-of-pocket maximum under Original Medicare. Your costs can keep adding up.
Medigap plans are designed to fill some or all of these gaps. However, Medigap plans themselves do not have official annual out-of-pocket maximums either, including Plan G and Plan N. Instead, they limit or eliminate many of the costs that would otherwise have no cap.
Medigap Plan G: Coverage, Costs, and Who It Fits
Plan G is one of the most comprehensive Medigap options available to new Medicare beneficiaries.
What Medigap Plan G covers
Plan G generally covers:
- Part A hospital coinsurance and all hospital costs up to an additional 365 days after Medicare benefits are used up
- Part A deductible
- Part A hospice care coinsurance or copayment
- Skilled nursing facility (SNF) care coinsurance
- First three pints of blood
- Part B coinsurance or copayment (the standard 20% you would normally pay)
- Part B excess charges (up to the legal limit where they are allowed)
- 80% of foreign travel emergency care, up to plan limits
Plan G does not cover:
- The Part B annual deductible
- Routine dental, vision, or hearing services (unless a carrier adds separate non-Medicare extras)
Once you have met the Part B deductible, Plan G typically pays 100% of your share of Medicare-approved Part B services for the rest of the year.
Out-of-pocket costs with Plan G
With Plan G, your main out-of-pocket medical cost exposure for Medicare-covered services is:
- The annual Part B deductible (you pay this yourself).
- Any costs for services Medicare does not cover at all (for example, most dental work, routine eye exams, and some hearing services).
- Possible costs if you use providers or services that are not covered by Medicare or are out of scope.
There is no formal Plan G out-of-pocket maximum, but practically, for covered Medicare services, your predictable annual exposure is largely the Part B deductible plus any non-covered services.
Who Plan G tends to fit
Plan G often works well for:
- People who want predictable costs and minimal surprise bills.
- Those who see specialists often, have chronic conditions, or expect higher usage of medical services.
- People in states where Part B excess charges are common or where they want peace of mind if they see providers who do not accept assignment.
You typically pay a higher monthly premium for Plan G compared to Plan N, in exchange for fewer copays and broader coverage of excess charges.
Medigap Plan N: Coverage, Copays, and Trade-Offs
Plan N is designed as a cost-sharing plan: you pay a lower monthly premium but agree to pay certain copays and possibly excess charges.
What Medigap Plan N covers
Plan N covers many of the same big items as Plan G, including:
- Part A hospital coinsurance and up to 365 extra hospital days
- Part A deductible
- Part A hospice care coinsurance or copayment
- Skilled nursing facility coinsurance
- First three pints of blood
- Part B coinsurance, with some exceptions
Plan N does not cover:
- The Part B annual deductible
- Part B excess charges
- Certain Part B copays, specifically:
- Up to a $20 copay for some office visits
- Up to a $50 copay for emergency room visits that do not result in an inpatient admission
As with Plan G, Plan N does not cover routine dental, vision, or hearing unless your carrier adds non-Medicare extras.
Out-of-pocket costs with Plan N
Your ongoing out-of-pocket exposure under Plan N can include:
- The annual Part B deductible.
- Office visit copays (up to $20) for certain Part B visits.
- Emergency room copays (up to $50) when you are not admitted.
- Part B excess charges when you see providers who do not accept Medicare assignment, in states where excess billing is allowed.
- Costs for services that Medicare does not cover.
Like Plan G, Plan N has no official annual out-of-pocket maximum. Your actual yearly spending will depend on how often you see doctors, use the ER, and whether your providers bill excess charges.
Who Plan N tends to fit
Plan N often works well for:
- People who want to lower their monthly premium and are comfortable with some copays.
- Those who do not see doctors frequently or who mostly use in-network providers that accept Medicare assignment.
- People in states that ban Part B excess charges, such as those with “Medicare Overcharge Measure” laws (e.g., New York, Pennsylvania, Ohio, and some others—always verify current rules with your state).
Plan N can be attractive if you are relatively healthy and willing to trade a bit of unpredictability in copays for monthly premium savings.
Plan G vs Plan N: Side-by-Side Out-of-Pocket Comparison
The core question many people have is: Which plan will cost me more out of pocket—Plan G or Plan N? The answer depends on both premiums and how you use healthcare.
Benefit comparison at a glance
For Medicare-covered services:
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A hospital coinsurance | Covered 100% | Covered 100% |
| Extra 365 hospital days | Covered | Covered |
| Part A deductible | Covered | Covered |
| SNF care coinsurance | Covered | Covered |
| Part A hospice coinsurance/copay | Covered | Covered |
| First 3 pints of blood | Covered | Covered |
| Part B coinsurance/copay | Covered 100% after deductible | Covered, except office & ER copays |
| Part B deductible | Not covered | Not covered |
| Part B excess charges | Covered | Not covered |
| Foreign travel emergency (up to limits) | 80% | 80% |
Out-of-pocket maximums: what you need to know
- Neither Plan G nor Plan N has an official annual out-of-pocket maximum.
- With Plan G, once you pay the Part B deductible, your out-of-pocket for Medicare-approved Part A and B services is usually minimal, assuming you stay within Medicare’s rules.
- With Plan N, you continue to pay office visit and ER copays throughout the year and may face excess charges, so your total out-of-pocket is less predictable.
How usage affects your costs
Consider these simplified scenarios (ignoring premiums for the moment and using generic numbers; verify current deductibles and copay rules each year):
Low usage (1–2 doctor visits, no hospital)
- Plan G: You pay the Part B deductible, then typically $0 for additional approved Part B services.
- Plan N: You pay the Part B deductible plus up to two office-visit copays (up to $20 each).
Result: Out-of-pocket is similar; Plan N might be slightly higher in medical costs but often has lower premiums.
Moderate usage (regular doctor visits, some specialists)
- Plan G: After the Part B deductible, most visits cost $0.
- Plan N: You may pay multiple $20 office-visit copays and possibly some ER copays over the year.
Result: Medical out-of-pocket tends to be higher with Plan N, but total cost depends on the premium difference.
High usage (multiple specialists, tests, possible ER visits)
- Plan G: After the Part B deductible, nearly all Medicare-approved Part B services are covered at 100%, including excess charges.
- Plan N: Copays add up, and if you see providers who bill excess charges, you may pay up to 15% above the Medicare-approved amount for Part B services.
Result: For heavy users or those seeing non-assignment providers, Plan G often leads to more predictable and potentially lower overall out-of-pocket costs.
Because there is no hard cap on your spending with either plan, your personal pattern of care is key in deciding which letter makes more sense.
Premiums, Rate Increases, and Long-Term Cost Considerations
Your monthly premium is the other major piece of the cost puzzle. Out-of-pocket costs and premiums must be viewed together.
Typical premium differences
In many areas:
- Plan G premiums are higher than Plan N premiums for the same age, gender, and tobacco status.
- Plan N premiums can be significantly lower, sometimes saving you hundreds of dollars per year.
However, premiums vary widely by:
- State and even county
- Insurance carrier
- Age and rating method (community-rated, issue-age-rated, or attained-age-rated)
- Enrollment timing and underwriting
Always compare multiple carriers in your area; the benefits are standardized, but prices are not.
Rate increases over time
Medigap premiums commonly increase over time due to:
- Age (if your plan uses attained-age rating)
- Medical inflation and rising claim costs
- Company-specific pricing and experience
When comparing Plan G vs Plan N, consider:
- Whether the premium savings with Plan N today are likely to offset its extra copays and possible excess charges over several years.
- How comfortable you are with potential future rate increases. Some carriers or plan types may have different rate-increase patterns, though this is not guaranteed.
Long-term value vs short-term savings
For some people, Plan N’s lower premium is worth the trade-off of copays and uncertain excess charges. For others, Plan G’s higher premium is a form of “insurance on your insurance,” helping keep out-of-pocket medical costs more predictable.
To evaluate long-term value:
- Estimate your expected number of office visits and ER visits in a typical year.
- Multiply those by the possible copays under Plan N.
- Add the Part B deductible (applies with both plans).
- Compare this total to the annual premium difference between Plan G and Plan N.
This kind of simple calculation can help you see which plan is more likely to be cost-effective for your situation—keeping in mind that health needs can change.
Choosing Between Plan G and Plan N for Your Situation
The “better” plan is the one that fits your health usage, risk tolerance, and budget.
Key questions to ask yourself
Ask yourself:
- How often do I typically see doctors or specialists each year?
- Am I comfortable paying copays when I use services in exchange for a lower premium?
- Do I live in a state that bans Part B excess charges, or are excess charges a real concern?
- How important is predictable spending versus saving on premiums now?
- Do I anticipate new or ongoing health conditions that may increase my usage of care?
When Plan G may be more suitable
Plan G may be a better fit if:
- You have chronic conditions or expect frequent medical visits and tests.
- You want to avoid the risk of excess charges altogether.
- You prefer simplicity: pay the Part B deductible and then have most Medicare-approved costs covered.
- The premium difference between Plan G and Plan N in your area is relatively small.
When Plan N may be more suitable
Plan N may be attractive if:
- You are relatively healthy and do not visit the doctor frequently.
- You live in a state that prohibits excess charges, reducing one of the main risks of Plan N.
- You want to lower your monthly premium and are comfortable with some pay-as-you-go copays.
- You are willing to monitor which providers you use (favoring those who accept Medicare assignment).
Because this is a financial and medical decision, it is wise to:
- Review current details on Medicare.gov.
- Check with your state department of insurance about excess charge rules.
- Speak with a licensed Medicare insurance agent to review options for your specific situation.
How to Shop, Compare Carriers, and Avoid Common Mistakes
Even though Plan G and Plan N benefits are standardized by letter, not all policies are equal when it comes to price, underwriting, and company practices.
Steps to shop and compare effectively
Confirm your eligibility and timing
- Know your Medigap Open Enrollment Period: the 6-month window starting the month you are both 65 or older and enrolled in Part B.
- During this time, you generally have guaranteed-issue rights and cannot be charged more or denied due to health conditions.
Compare multiple carriers
For each of Plan G and Plan N in your area, compare:- Monthly premium
- Rating method (community, issue-age, or attained-age)
- Household discounts or other legitimate premium discounts
- Financial strength and customer service reputation (use third-party ratings where available)
Ask about underwriting if you are switching
- Outside of open enrollment or special guaranteed-issue periods, carriers can usually ask health questions.
- You may be denied, rated up, or have waiting periods for pre-existing conditions, depending on state rules.
Check provider billing practices
- Ask your key doctors whether they accept Medicare assignment.
- If they do not, consider how often you see them and how that could affect excess charges under Plan N.
Common mistakes to avoid
- Choosing only by lowest premium: Extremely low premiums can be tempting, but may come with steeper rate increases later or limited service.
- Ignoring state-specific rules: Some states have unique Medigap rules, including community rating or bans on excess charges. Always verify local regulations.
- Assuming you can easily switch later: Moving from Plan N to Plan G later usually requires underwriting unless you have a new guaranteed-issue right.
- Confusing Medigap with Medicare Advantage: Medigap supplements Original Medicare; it is not the same as a Medicare Advantage (Part C) plan and does not include Part D drug coverage.
Take your time to compare options, and consider reviewing your choices with a licensed professional who can explain carrier-specific details without steering you to any particular company.
Summary: Which Medigap Plan Offers Better Value for You?
Plan G and Plan N both provide strong protection against the major gaps in Original Medicare, but they manage out-of-pocket costs in different ways.
- Plan G: Higher premium, very low and predictable out-of-pocket costs after you meet the Part B deductible, and protection from Part B excess charges. It often suits people who want maximum predictability and expect moderate to heavy healthcare usage.
- Plan N: Lower premium, but ongoing exposure to office and ER copays and possible Part B excess charges. It can be a good fit if you are healthy, live in a state that limits or bans excess charges, and are comfortable with some variability in your annual spending.
Neither plan has a formal out-of-pocket maximum, but Plan G effectively limits most of your Medicare-covered expenses once you have paid the Part B deductible. Plan N leaves more room for variable costs depending on how often you see doctors and which providers you choose.
Because Medigap pricing, availability, and rules vary by state and carrier, and because health and financial situations are personal, use this information as a starting point. Then confirm specifics with Medicare.gov, your state insurance department, or a licensed Medicare insurance agent.
Disclaimer: This article is for informational purposes only and does not constitute insurance, financial, or medical advice. Medicare rules, plan availability, and costs change over time and vary by location. Always verify details with official sources and consult a licensed professional before making enrollment decisions.
FAQ
Does Medigap Plan G have an out-of-pocket maximum?
Medigap Plan G does not have a formal annual out-of-pocket maximum. However, once you meet the Medicare Part B annual deductible, Plan G generally covers all Medicare-approved Part A and Part B costs that Original Medicare leaves behind, aside from services Medicare itself does not cover.
Does Medigap Plan N have an out-of-pocket maximum?
Medigap Plan N has no official annual out-of-pocket maximum. You are responsible for the Part B deductible, office visit and ER copays, and any Part B excess charges where they are allowed, plus any costs for services Medicare does not cover.
Is Medigap Plan G or Plan N cheaper overall?
Plan N usually has a lower monthly premium than Plan G. Your total yearly cost, though, depends on how often you see doctors, how many copays you pay, whether your providers bill Part B excess charges, and the premium difference between the two plans in your area.
Can I switch from Medigap Plan N to Plan G later?
You can apply to switch from Plan N to Plan G at any time, but outside your Medigap open enrollment or a guaranteed-issue period, insurers can typically use medical underwriting. That means you may have to answer health questions and could be declined or charged a higher premium based on your medical history, depending on state rules.
Do Plan G and Plan N cover the Medicare Part B deductible?
Neither Plan G nor Plan N covers the Medicare Part B annual deductible. You must pay that amount out of pocket each year before your Medigap benefits for Part B services begin to pay their share.