Medigap Plan G vs. Plan N: 2025 Comparison
Plan G and Plan N are the two most popular Medigap plans sold today. Both provide excellent coverage — but they differ in monthly premium, office-visit copays, and how they handle "excess charges." Here's the full breakdown so you can decide which saves you more money over the long run.
Side-by-Side Benefits Comparison
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A hospital coinsurance & costs up to 365 extra days after Medicare benefits end | ✅ Covered 100% | ✅ Covered 100% |
| Part A deductible ($1,676 per benefit period in 2025) | ✅ Covered 100% | ✅ Covered 100% |
| Part A hospice care coinsurance or copayment | ✅ Covered 100% | ✅ Covered 100% |
| Skilled nursing facility coinsurance | ✅ Covered 100% | ✅ Covered 100% |
| Part B deductible ($257 in 2025) | ❌ Not covered — you pay | ❌ Not covered — you pay |
| Part B coinsurance (20% of Medicare-approved amount) | ✅ Covered 100% | ✅ Covered 100% (with exceptions) |
| Office visit copay (doctor visits) | ✅ $0 always | ⚠️ Up to $20 copay per visit |
| Emergency room copay (non-emergency visit) | ✅ $0 | ⚠️ $50 copay (waived if admitted) |
| Part B excess charges (up to 15% above Medicare rate) | ✅ Covered 100% | ❌ Not covered — you pay |
| Foreign travel emergency (80% after $250 deductible) | ✅ Covered | ✅ Covered |
| Blood (first 3 pints per year) | ✅ Covered 100% | ✅ Covered 100% |
What Are Part B Excess Charges?
When a doctor does not accept Medicare assignment (meaning they don't agree to accept Medicare's approved amount as full payment), they can charge up to 15% more than Medicare's approved rate. This extra amount is called an excess charge.
Example: Medicare approves $200 for a procedure. A non-participating doctor bills $230. The extra $30 is the excess charge. Plan G pays it. Plan N leaves it to you.
In practice, excess charges affect a relatively small percentage of services — about 1% of Medicare claims nationally involve excess charges. The vast majority of doctors either accept Medicare assignment fully or don't see Medicare patients at all.
States Where Excess Charges Are Banned
In the following states, providers are legally prohibited from charging above the Medicare-approved amount. If you live in one of these states, the excess charge risk under Plan N is essentially zero — making Plan N equivalent to Plan G on this feature:
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
If you live in one of these 8 states, Plan N becomes functionally identical to Plan G except for the doctor visit and ER copays.
Premium Comparison: How Much Does Each Plan Cost?
Plan N premiums are typically 15–30% lower than Plan G premiums for the same beneficiary in the same market. Actual amounts vary widely by insurer, age at enrollment, geographic rating area, and pricing method. As of 2025:
| Age at Enrollment | Typical Plan G Monthly Premium | Typical Plan N Monthly Premium | Monthly Savings with Plan N |
|---|---|---|---|
| 65 | $110–$160 | $80–$120 | ~$30–$50 |
| 70 | $130–$200 | $100–$155 | ~$35–$55 |
| 75 | $160–$250 | $125–$190 | ~$40–$70 |
These are representative ranges. Get actual quotes for your ZIP code and age — premiums can vary 3x between the cheapest and most expensive insurer offering identical benefits.
The Breakeven Analysis: When Does Plan G Save You Money?
Plan N saves you money on premiums. Plan G saves you money on copays and excess charges. The question is: at what point do Plan N's out-of-pocket costs exceed the premium savings?
Doctor Visit Breakeven
Assume Plan G costs $40/month more than Plan N ($480/year premium savings for Plan N). Plan N charges up to $20 per doctor visit. Break-even point: 24 doctor visits per year (480 ÷ 20 = 24). If you see a doctor more than 24 times per year, Plan G saves you money on the visits alone.
For someone with frequent specialist visits — say, 3–4 visits per month — Plan G often wins despite the higher premium.
ER Visit Breakeven
The $50 ER copay under Plan N is waived if you're admitted to the hospital. It applies only to non-emergency ER visits. If you visit the ER twice per year without being admitted, that's $100 in additional Plan N costs — about 2–3 months' worth of premium savings depending on your plan.
Typical Scenarios
| User Profile | Plan G Likely Better? | Plan N Likely Better? |
|---|---|---|
| Generally healthy, 3–5 doctor visits/year | ✅ Premium savings outweigh copays | |
| Chronic condition, 8–15 doctor visits/year | ✅ G's zero copays offset premium difference | |
| Sees non-participating (non-assignment) doctors | ✅ Excess charge protection matters | |
| Lives in excess-charge-ban state, moderate visits | ✅ Plan N equivalent to G minus ER/office copays | |
| Specialist-heavy care (cardiology, oncology) | ✅ Copays accumulate quickly | |
| Budget-conscious, very healthy at 65 | ✅ Lower premium every month; copays are manageable |
Premium Inflation: A Long-Term Consideration
Both Plan G and Plan N premiums increase over time due to general medical inflation and claims experience. However, the rate of increase is not identical:
- Plan G has been one of the most popular plans since Plan F was discontinued for new enrollees in 2020. Large enrollment pools tend to stabilize premiums.
- Plan N tends to attract healthier beneficiaries (those confident they won't need frequent doctor visits). This can keep Plan N premiums stable or create adverse selection over time as the Plan N pool ages.
When evaluating the long-term cost, consider not just today's premium but the insurer's rate increase history. Request the insurer's 5-year rate increase history before purchasing either plan.
Which Plan Is Better for People with Specific Conditions?
| Condition | Recommended Plan | Reason |
|---|---|---|
| Cancer (active treatment) | Plan G | Frequent specialist/infusion visits; $20 copays accumulate rapidly |
| Heart disease (regular cardiology care) | Plan G | Quarterly specialist visits, potential procedures |
| Diabetes (well-controlled, few visits) | Plan N | Premium savings likely outweigh modest copay exposure |
| Mental health (regular therapy) | Plan G | Weekly therapy = $20 × 52 visits = $1,040/year in Plan N copays |
| Generally healthy at enrollment | Plan N | Low utilization; premium savings real; copays manageable |
| Parkinson's, MS (high utilization) | Plan G | Neurologist, PT, OT, speech visits add up quickly |
Frequently Asked Questions
In most states, switching from Plan N to Plan G requires medical underwriting — the insurer can ask about your health and decline you or charge more. The safe window to get either plan without underwriting is your 6-month Medigap Open Enrollment Period starting when you turn 65 and enroll in Part B. Some states have birthday rules that allow annual switching without underwriting. Check your state's rules before choosing Plan N with the assumption you can upgrade to G later.
For a healthy 65-year-old with few medical needs, Plan N's lower premium often makes mathematical sense in the short term. The risk is that if your health changes and you start seeing doctors frequently, the $20 copays can add up. Some advisers recommend Plan G for the peace of mind and simplicity, knowing that no visit will cost you anything beyond the Part B deductible. There's no universally right answer — it depends on your health outlook and risk tolerance.
No. Neither Plan G nor Plan N covers the Part B deductible ($257 in 2025). You pay this once per year before either plan's benefits kick in for Part B services. Plan F did cover the Part B deductible, but Plan F is no longer available to people who became Medicare-eligible after January 1, 2020.
No. Medigap plans do not cover prescription drugs. You need a separate Part D Prescription Drug Plan (PDP) for medication coverage. All Medigap plans sold after January 1, 2006 are prohibited from including drug coverage.