Compare Medigap Plan G and Plan N: The 3-Step Decision Puzzle
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Compare Medigap Plan G and Plan N: The 3-Step Decision Puzzle
Choosing between products isn’t always easy, especially when there are multiple options. Have you ever gone to buy toothpaste, only to find out there are seemingly 50 different types? Maybe you’ve experienced frustration when purchasing a new vehicle because the models are similar but offer a bevy of different features.
That can be the case when deciding in which Medigap plan to enroll. Medicare Supplement (Medigap) plans are standardized private insurance policies that help pay for out-of-pocket costs Original Medicare doesn’t cover, including copayments, coinsurance, and deductibles. Plans are labeled by letter, and each letter offers a specific set of benefits regulated by federal and state law.
Deciding between Medicare Supplement Plans G and N comes down to some shared benefits and a few key differences. Both cover Part A coinsurance for up to 365 extra hospital days, the Part A deductible, skilled nursing facility coinsurance, Part A hospice coinsurance, the first three pints of blood, and some foreign travel emergency coverage. Neither, however, covers the Part B deductible.
The differences between Medigap Plans G and N can make the decision more difficult. Plan G covers Part B excess charges, but Plan N doesn’t. Plan N can include a cost of up to $20 for office visits and up to $50 for some emergency department (ED) visits, but Plan G has no copays for either. As a trade-off, Plan G usually carries a higher monthly premium than Plan N, which trades a lower premium for more Medigap copays.
This three-step decision puzzle answers the Medigap Plan G vs. Plan N question with a simple formula, which includes three numbers from your own situation, plugged into one comparison. The table below highlights the full side-by-side comparison for quick reference:
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A Deductible | Covered | Covered |
| Part A Coinsurance (365 extra days) | Covered | Covered |
| Skilled Nursing Facility Coinsurance | Covered | Covered |
| Part B Coinsurance | Covered (100%) | Covered (with copays) |
| Part B Deductible | Not covered | Not covered |
| Part B Excess Charges | Covered | Not covered |
| Office Visit Copay | $0 | Up to $20 |
| ED Visit Copay (not admitted) | $0 | Up to $50 |
| Foreign Travel Emergency | Covered | Covered |
| Blood (first 3 pints) | Covered | Covered |
Understanding the 3-Step Decision Puzzle
You don’t need to be a math wiz to figure out whether Plan G or N is the best option for you. All you need is three numbers that comprise a three-step decision puzzle that turns the choice into simple math.
The three puzzle pieces consist of:
- A = Annual Premium Difference: Plan G premium minus Plan N premium
- B = Expected number of doctor office visits per year
- C = Expected number of ED visits per year that don’t require hospital admission
If A > (B × $20) + (C × $50), then Plan N is the better financial choice.
This works because the copays of Plan N are capped at $20 per office appointment and $50 per ED visit, which are worst-case amounts, not guaranteed charges. If your premium savings exceed those maximum copays, Plan N benefits you financially.
This formula only covers premiums and copays, though. Part B excess charges, which we’ll cover later in this article, add another layer of consideration to which option you select. In this next section, we delve more into each puzzle piece of the equation.
Step #1: Calculate the Annual Premium Difference
First, procure personalized quotes for both Plans G and N in your ZIP code. Any real Medicare Supplement comparison should include this step because Medigap premiums vary by state and ZIP code. A national average won’t reflect your actual exposure.
To calculate A, multiply each monthly premium by 12, then subtract the Plan N annual total from the Plan G annual total. For example, if Plan G costs $180/month and Plan N runs $145/month, A = ($180 − $145) × 12 = $420/year.
Nationally, Plan N consistently has lower premiums, typically $20–$40 per month, than Plan G. Nevertheless, local variation can be big, so it’s best to get an actual quote.
Step #2: Estimate Expected Doctor Visits and Copay Costs
Next, estimate how many times per year you visit a doctor’s office for Part B services. Plan N can charge a maximum of $20 for some office visits, but actual copays may run lower, especially in rural areas.
A quick reference for maximum annual office-visit copay exposure:
- 4 visits/year × $20 = $80 maximum annual copay exposure
- 8 visits/year × $20 = $160 maximum annual copay exposure
- 12 visits/year × $20 = $240 maximum annual copay exposure
Not every doctor’s visit requires a copay. Plan N pays full Part B coinsurance for other services, such as lab work and imaging, that are billed separately.
Step #3: Assess Emergency Department Visits and Copay Costs
Plan N can charge up to $50 for some ED visits, but only for visits that don’t result in inpatient admission. If the visit leads to admission, there’s no copay.
Most beneficiaries average fewer than one non-admission ED visit per year. Use your health history to estimate C:
- 0 ED visits × $50 = $0
- 1 ED visit × $50 = $50
- 2 ED visits × $50 = $100
By comparison, Plan G doesn’t have any copays for routine office or ED visits. Therefore, its cost for these scenarios is always $0 beyond the premium.
How to Use the Puzzle Formula to Choose the Best Plan
Use all three puzzle pieces to help you make your decision on whether Plan G or N is best for you. Again, the decision rule should be made using the following equation:
If A < (B × $20) + (C × $50), Plan G is the better value for you.
As this equation indicates, when the premium savings from choosing Plan N exceed the maximum copays you’d pay under it, Plan N is a better financial option.
$185/month → $2,220/year
$150/month → $1,800/year
$2,220 − $1,800 = $420
6 × $20 = $120
1 × $50 = $50
$120 + $50 = $170
$420 > $170 → Plan N wins
It’s important to note that this formula uses maximum copay amounts and doesn’t account for Part B excess charges. The next section covers that piece of the puzzle.
Important Coverage Considerations Beyond Premiums and Copays
The three-step puzzle covers the most common cost variables, but three other factors should be taken into account before you decide between Plans G and N. These include Part B excess charges, provider acceptance of Medicare assignment, and regional copay and premium variations.
Factor #1: Part B Excess Charges
Medicare Part B excess charges are additional fees up to 15% above the Medicare-approved amount that healthcare providers who don’t accept Medicare assignment can bill patients. Plan G fully covers these charges, but Plan N doesn’t, leaving enrollees responsible for the extra cost.
However, excess charges are uncommon, since about 98% of non-pediatric physicians are participating providers, which means they accept assignment on all Medicare claims. Eight states, including Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, prohibit or restrict Part B excess charges.
Factor #2: Provider Acceptance of Medicare Assignment
Medicare assignment means that a healthcare provider agrees to accept Medicare’s approved amount as full payment for covered services. Providers who accept assignment cannot bill patients for Part B excess charges. Confirming assignment status with your doctors is essential before selecting Plan N.
To verify Medicare assignment status before enrolling, we recommend that you contact your physicians’ billing offices or check the Medicare.gov provider directory. If your physicians don’t accept assignment, Plan N could cost you extra in copays and excess charges, making Plan G the more financially sound option, depending on the premium gap.
Factor #3: Regional Variations in Copays and Premiums
Medigap premiums vary by state and ZIP code. Also, not every plan is available everywhere.
In low-cost rural areas, Plan N copayments may be lower than the $20 and $50 maximums used in the three-step puzzle formula, resulting in Plan N being even more financially advantageous.
States including Florida and Minnesota have unique Medigap regulations affecting pricing and availability. In these states, a localized quote beats a national average. A high-deductible version of Plan G is also available in most states but requires paying up to $2,950 in covered costs in 2026 before the policy pays, offering another route to a lower premium.
Real-Life Examples Applying the 3-Step Puzzle
Example #1: Sylvia, a 67-Year-Old Living in a Mid-Sized Ohio City
| Variable | Value |
|---|---|
| Plan G monthly premium | $175/month → $2,100/year |
| Plan N monthly premium | $140/month → $1,680/year |
| A (Annual Premium Difference) | $420 |
| B (Expected doctor visits) | 8 (4 primary care + 2 specialists twice each) |
| C (Expected ED visits, conservative) | 1 |
| Maximum copay exposure | (8 × $20) + (1 × $50) = $210 |
| Result | $420 > $210 → Plan N saves $210/year at maximum copays |
Example #2: A High-Utilization Client in the Same Ohio City
| Variable | Lower-Utilization Example | High-Utilizer |
|---|---|---|
| B/C (visits) | 8/1 | 14/2 |
| Maximum Copay Exposure | $210 | $380 |
| Formula Result | $420 > $210 | $420 < $380 |
| Better Choice | Plan N | Plan G (or a close call for Plan N) |
Sylvia should still confirm that her doctors accept Medicare assignment. Why? Because if her specialist doesn’t, excess charges make Plan G a better choice, even when the copay math shows that Plan N is a better option.
Premiums vs. Copays Over Time
The premium difference between Plans G and N tends to widen over time. Plan G attracts a broader range of enrollees, including those with higher healthcare needs, putting more claims pressure on its risk pool and causing steeper increases. Plan N requires medical underwriting at enrollment, which is designed to filter for healthier beneficiaries and tends to produce more moderate rate increases.
Meanwhile, the maximum copays ($20 for office appointments and $50 for ED visits) are set by federal regulation and haven’t changed in years because they aren’t automatically adjusted for inflation. Therefore, the difference between Plan G and N premiums typically grows while the copay side of the formula stays fixed. That’s why Plan N often becomes more favorable the longer a policyholder holds it.
The table below illustrates this widening gap over five hypothetical years for a policyholder with eight annual office visits and one ED visit:
| Year | Plan G Annual | Plan N Annual | A (Difference) | Maximum Copays | Net Savings with Plan N |
|---|---|---|---|---|---|
| 2026 | $2,100 | $1,680 | $420 | $210 | $210 |
| 2028 | $2,352 | $1,860 | $492 | $210 | $282 |
| 2030 | $2,640 | $2,064 | $576 | $210 | $366 |
Rate increases vary by insurer and state, so treat this table only as an example. For broader context, see AAMSI’s coverage of why Medigap plans seniors increasingly favor lower-cost options.
Choosing the Best Medigap Plan for Your Healthcare Needs
Finding the Medigap plan that best suits your needs amounts to matching the math to your own risk tolerance and healthcare habits. Opt for Plan N if premium savings exceed your maximum expected copays, your doctors accept Medicare assignment, and you’re satisfied with occasional small copays. Choose Plan G if you want minimal, predictable out-of-pocket costs or see providers who may not accept assignment, which costs more monthly but eliminates the guesswork.
If A > (B × $20) + (C × $50), Plan N is the better financial choice. If not, it’s Plan G.
Don’t neglect to get personalized Plan G and Plan N quotes for your ZIP code. For guidance customized to your health profile and provider landscape, consult a licensed Medicare agent. AAMSI maintains local agent directories in multiple markets, including Cook County, Illinois, Minneapolis–St. Paul, and Houston, Texas. The AAMSI FAQ page answers other common Medigap questions.
Using our three-step puzzle, choosing between Medigap Plan G and Plan N doesn’t have to be confusing. Whichever plan you select, be sure to enroll on time. More than 90% of seniors said they would be concerned about losing their financial security if they didn’t have Medicare Supplement coverage, and Medicare enrollees without Medigap coverage were twice as likely to have problems paying medical bills.
The best time to enroll in Medigap is during your six-month Open Enrollment Period, starting when you turn 65 and enroll in Part B. During this window, carriers cannot deny you, charge more, or ask health questions. Outside of it, medical underwriting typically applies. Certain qualifying events can trigger guaranteed issue rights, allowing you to enroll in Medigap at other times.
Frequently Asked Questions
Is Plan G more expensive than Plan N?
Yes. Nationally, the difference usually runs $20 to $40 per month, although it varies by state, ZIP code, age, and insurer.
What are Part B excess charges, and which plan covers them?
Part B excess charges are additional fees of up to 15% above Medicare’s approved amount that doctors who don’t accept Medicare assignment can bill you. Plan G covers these fully, but Plan N doesn’t.
How do copayments affect the cost-effectiveness of Plan N?
Plan N can charge up to $20 for some office visits and up to $50 for certain ED visits if you’re not admitted. If your total annual copays stay below the premium savings versus Plan G, Plan N is the more cost-effective choice.
Which plan is better for frequent doctor visits?
Plan G is typically the best choice for frequent doctor visits because it has no office or ED copays. Plus, it covers Part B excess charges, giving highly predictable costs year-round.
Can I switch between Plan N and Plan G later?
Yes, but you may face medical underwriting depending on your state and insurer, which could mean a higher premium or denial based on pre-existing conditions.
