Medigap Plan G vs Plan N: The Real Difference Isn't the Copays
Most comparisons stop at "Plan N has copays, Plan G doesn't." The bigger, uncapped difference is Part B excess charges, and most people have never heard of them.
Plan G and Plan N cover exactly the same things, with two exceptions. Plan N charges a copay of up to $20 for some office visits and up to $50 for ER visits that don't result in admission; Plan G covers both in full. And Plan G covers Part B excess charges (the extra amount a provider who doesn't accept Medicare assignment can legally bill above the Medicare-approved rate, up to 15%); Plan N doesn't. In practice, Plan N's copays are capped and rarely cost much over a year — the harder-to-predict risk is the excess-charge gap, which isn't capped at all and depends heavily on which state you live in.
This site's Medigap Plan Comparison Tool lays out all 10 standardized plan letters side by side. Plan G and Plan N are the two most commonly chosen by people newly eligible for Medicare, and they get compared constantly, but most comparisons stop at the copay difference and never mention the one that actually carries more financial risk. This post covers both, with the actual math.
What's identical between the two plans
It's worth being precise about how similar Plan G and Plan N actually are, since it's easy to assume a lettered plan two steps apart on a benefit grid must be meaningfully different. Both cover Part A coinsurance and up to 365 extra hospital days at 100%, the first 3 pints of blood, Part A hospice coinsurance, skilled nursing facility coinsurance, and the Part A deductible, in full. Both leave the annual Part B deductible ($283 in 2026) to the enrollee — neither plan covers it. Both cover foreign travel emergency care at 80% after a $250 deductible, up to the plan's lifetime limit. The entire comparison comes down to two line items.
Difference #1: the copays, and what they actually add up to
Plan N covers Part B coinsurance, but with a copay of up to $20 for some office visits and up to $50 for an ER visit that doesn't result in an inpatient admission. Because the copay is a flat, capped dollar amount rather than a percentage of the bill, it's straightforward to estimate a worst-case annual cost: even someone seeing a doctor twice a month, 24 visits a year, would pay at most $480 in office copays for the year, plus whatever ER copays apply.
Plan N's monthly premium is commonly quoted in industry pricing surveys as running roughly $40 to $80 less than Plan G's at the same age, insurer, and location — real premiums vary far too much by carrier, state, age, and tobacco use to state as a single number, but that range shows up consistently across multiple pricing sources. At the low end of that range, $40/month, the annual premium savings from choosing Plan N is $480 — which already roughly offsets even a fairly heavy year of office-visit copays. At the higher end, $80/month, the annual savings is $960, comfortably ahead of what most people would plausibly pay in Plan N copays in a year. For most people, on the copay comparison alone, Plan N's lower premium wins.
Plan N Copays
Up to $20 per office visit, up to $50 per non-admitted ER visit. Capped per visit, not a percentage of the bill.
Typical Premium Gap
Commonly quoted at roughly $40-$80/month less for Plan N than Plan G — varies significantly by carrier, state, age, and tobacco use.
Part B Excess Charges
Up to 15% above the Medicare-approved rate. Plan G covers this in full; Plan N covers none of it.
States Restricting Excess Charges
Most commonly cited: CT, MA, MN, NY, OH, PA, RI, VT — with real variation in how complete each state's protection actually is.
Difference #2: Part B excess charges, the uncapped one
This is the difference that gets far less attention than the copays, despite being the one without a ceiling. Most doctors accept Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment. Some don't. A provider who doesn't accept assignment is legally allowed to bill up to 15% more than the Medicare-approved rate for a given service — this extra amount is the "Part B excess charge." Plan G covers it in full, as part of what makes it the most comprehensive plan available to people newly eligible for Medicare. Plan N does not cover it at all, leaving the enrollee to pay the full excess amount out of pocket.
Unlike Plan N's office and ER copays, which are capped at a small flat dollar amount no matter how large the underlying bill is, an excess charge scales with the size of the bill itself — 15% of a large procedure is a meaningfully larger number than 15% of a routine office visit, and there's no annual cap the way there is with Plan K or Plan L's out-of-pocket limits. For someone who happens to see a provider who doesn't accept assignment for an expensive service, the gap between what Plan G and Plan N would have covered could easily exceed a year's worth of premium savings in a single bill.
Whether this risk matters in practice depends heavily on geography. Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont are the states most commonly cited as restricting excess charges by state law or regulation — but that list deserves a caveat most comparison articles skip: the level of protection isn't uniform across it. Massachusetts, Minnesota, Ohio, and Pennsylvania have broad prohibitions that block excess charges in most ordinary situations. Connecticut, New York, Rhode Island, and Vermont have narrower rules with real exceptions — New York, for instance, still permits providers to bill up to 5% above the Medicare-approved amount, not a full prohibition. In the roughly 40 remaining states with no such restriction, a provider who doesn't accept assignment can legally bill the full 15% excess charge, and Plan N enrollees are exposed to all of it.
So which one is actually the smarter bet?
Based on the math above, Plan N is the stronger default for most people: the copay exposure is small and capped, and the premium savings usually outweighs it. The case for Plan G gets stronger specifically for people who live in one of the roughly 40 states with no excess-charge restriction and who are likely to see providers who don't accept Medicare assignment — a real possibility for anyone who travels frequently, sees specialists, or lives somewhere with fewer Medicare-assignment providers to choose from. It's worth asking a prospective provider directly whether they accept Medicare assignment before assuming Plan N's lower premium is a clean win.
Frequently Asked Questions
What's the actual difference between Medigap Plan G and Plan N?
Only two things. Plan N charges a copay of up to $20 for some office visits and up to $50 for ER visits that don't result in admission, while Plan G covers those in full. And Plan G covers Part B excess charges, the amount a provider who doesn't accept Medicare assignment can bill above the Medicare-approved rate, while Plan N does not. Every other benefit is identical between the two plans.
How much can Plan N's copays actually add up to in a year?
Even with frequent care, usually a few hundred dollars a year at most, since the copay is capped per visit (up to $20 for an office visit, up to $50 for a non-admitted ER visit) rather than a percentage of the bill. For most people, the monthly premium savings from choosing Plan N over Plan G exceeds what the copays end up costing over the year.
What are Medicare Part B excess charges, and does Plan N cover them?
A Part B excess charge is the extra amount, up to 15% above the Medicare-approved rate, that a provider who doesn't accept Medicare assignment is legally allowed to bill. Plan G covers this in full; Plan N does not, leaving the enrollee responsible for the excess amount. Unlike Plan N's capped office and ER copays, this exposure isn't capped by the plan itself.
Which states don't allow Medicare Part B excess charges?
Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont are the states most commonly cited as restricting excess charges, but the level of protection genuinely varies within that list. Massachusetts, Minnesota, Ohio, and Pennsylvania have broad prohibitions; Connecticut, New York, Rhode Island, and Vermont have narrower rules with real exceptions (for example, New York still permits providers to bill up to 5% above the Medicare-approved amount). In the roughly 40 remaining states, providers who don't accept assignment can bill up to the full 15% excess charge.
Is Plan N or Plan G cheaper overall?
Plan N usually costs less overall for people who don't see excess-charge-billing providers often, since its lower premium typically outweighs its capped copays. Plan G usually costs less in total for people who live in a state without excess-charge protections and who see providers who don't accept Medicare assignment, since a single excess-charge bill isn't capped the way Plan N's copays are. There's no single right answer independent of where you live and which providers you use.
This article explains general, federally standardized Medigap benefits and 2026 cost-sharing figures as of August 2026. It is not insurance advice and does not estimate specific premium quotes, which vary by insurance company, age, gender, tobacco use, and location. For free, unbiased, one-on-one help comparing actual Medigap quotes, contact your State Health Insurance Assistance Program (SHIP).