Medicare Supplement · Plan G vs Plan N
Plan G vs Plan N: How the Break-Even Math Actually Works in 2026
Pick the cheaper premium today and you may lose the right to switch back later. The math is simple; the timing rules are not.
Where are you in your Medicare journey?
01 · New to Medicare I'm turning 65 and picking my first Medigap plan → Open enrollment walkthrough — no health questions asked
Your six-month Medigap Open Enrollment Period is the one window where every carrier must accept you regardless of health. It is also the only time the Plan G / Plan N decision is fully reversible.
Price both plans for your ZIP in Plan Match or call (828) 761-3326.
02 · Already enrolled I have a Medigap plan and want to compare 2026 rates → Rate review — and an underwriting check before you apply
Switching carriers usually means answering health questions. I check whether you would pass underwriting before anything gets submitted, so a rejected application never lands on your record.
03 · Helping family I'm helping my parent or spouse choose → Family call — I talk with both of you at once
We can walk the comparison together on one call so nobody is relaying numbers secondhand. Bring the doctor list and any current plan paperwork.
Call (828) 761-3326 or start in Plan Match.
Prefer to just talk? (828) 761-3326
Plan G and Plan N cover the same core benefits. They differ in three places: Plan N charges copays of up to $20 per office visit and up to $50 per emergency room visit, Plan N does not cover Part B excess charges, and Plan N's premium runs roughly $20 to $50 per month lower. Neither plan covers the Part B deductible, which is $283 in 2026.
Which one wins comes down to arithmetic you can do in about a minute: how much you save in premium each year versus how much you spend on copays and excess charges. Below is the math, the state rules that change the answer, and a tool that runs it against real quotes for your ZIP code.
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A deductible ($1,736 in 2026) | Covered | Covered |
| Part A coinsurance and hospital costs | Covered | Covered |
| Part B coinsurance | Covered in full | Covered, minus copays |
| Office visit copay | None | Up to $20 per visit |
| Emergency room copay | None | Up to $50, waived if admitted |
| Part B excess charges (up to 15%) | Covered | Not covered |
| Part B deductible ($283 in 2026) | Not covered | Not covered |
| Skilled nursing facility coinsurance | Covered | Covered |
| Foreign travel emergency | 80% to plan limits | 80% to plan limits |
| Typical monthly premium | Higher | $20–$50 lower |
Compare with real quotes
See both plans priced for your ZIP code
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Generation Health is a licensed insurance agency. We are not connected with or endorsed by the United States government or the federal Medicare program.
How many doctor visits does it take for Plan G to beat Plan N?
Divide your annual premium savings by $20. That's roughly how many office visits Plan N absorbs before it stops being the cheaper plan.
If Plan G quotes at $175 a month and Plan N at $130, you save $45 a month — $540 a year. At $20 per office visit, Plan N stays ahead until you hit about 27 visits in a year. Most people never get close, which is why Plan N looks obviously correct on a spreadsheet.
Two things break that spreadsheet. The first is Part B excess charges: if a provider does not accept Medicare assignment, they can bill up to 15% above the Medicare-approved amount, and Plan N leaves you paying it. One surgery with a non-participating specialist can erase several years of premium savings. The second is that premiums are not frozen — Plan G and Plan N blocks do not rise at the same rate, and the gap you're quoting today is not the gap you'll have in five years.
Do Part B excess charges apply where you live?
Eight states limit or prohibit Part B excess charges: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont. If you live in one of them, the single strongest argument for Plan G largely disappears.
The protection is not uniform, and this is where most comparisons stop being useful. Massachusetts, Minnesota, Ohio and Pennsylvania have broad statutory bans. The other four are narrower — New York caps the excess charge at 5% rather than eliminating it, and Connecticut's protection is tied to specific enrollment circumstances. Minnesota's ban protects Minnesota residents but does not necessarily follow you to an out-of-state facility.
Everywhere else, the exposure is real but uncommon. Roughly 2% of participating providers bill excess charges — concentrated heavily in certain specialties. Low probability, uncapped severity. That is precisely the risk profile insurance exists to handle, which is the honest case for Plan G in the other 42 states.
Can you switch from Plan N to Plan G later?
Usually not without answering health questions. This is the part almost every Plan G vs Plan N comparison leaves out, and it matters more than the copay schedule.
Outside your six-month Medigap Open Enrollment Period, carriers in most states can medically underwrite you — review your health history and decline you. About 16 states run an annual "birthday rule" window that lets you change plans without underwriting, but those windows typically permit a move to equal or lesser benefits only. Plan G to Plan N passes that test. Plan N to Plan G generally does not.
Picking Plan G leaves you a door back to Plan N if you want the lower premium later. Picking Plan N may close the door to Plan G permanently, the moment your health changes. Weigh that before you optimize for $45 a month.
What exactly triggers the Plan N copay?
The copay attaches to office visits — not to lab work, x-rays, or durable medical equipment. Per CMS guidance to carriers, it applies to standard evaluation-and-management office visit codes, plus certain ophthalmology and psychotherapy codes.
What that means in practice: a specialist visit is billed on the same office-visit codes as your primary care visit, so it carries the same copay. Standalone bloodwork does not. Two separate visits on the same day can each carry a copay. The emergency room copay is a single charge of up to $50, not $50 plus an office copay, and it is waived if you're admitted as an inpatient.
Urgent care and telehealth are the genuinely unsettled ground. The original CMS guidance exempted them, but billing has shifted since — telehealth is now commonly submitted as an office-visit code with a modifier, and carriers do not all handle it the same way. If you use either regularly, ask the specific carrier in writing before you enroll rather than relying on a general comparison.
Common questions
What is the biggest difference between Plan G and Plan N?
Plan N charges copays of up to $20 per office visit and up to $50 per emergency room visit, and does not cover Part B excess charges. Plan G has no copays and covers excess charges in full. Neither plan covers the Part B deductible, which is $283 in 2026.
How much cheaper is Plan N than Plan G?
Plan N premiums typically run $20 to $50 per month below Plan G, or roughly $240 to $600 per year. The exact gap depends on your ZIP code, age, tobacco use and carrier.
Can I switch from Plan N to Plan G later?
Usually not without medical underwriting. Outside your six-month Medigap Open Enrollment Period, carriers in most states can review your health history and decline the application. States with an annual birthday-rule window generally allow moves to equal or lesser benefits only, which permits Plan G to Plan N but not Plan N to Plan G.
Does Plan N cover Part B excess charges?
No. If a provider does not accept Medicare assignment, they may bill up to 15% above the Medicare-approved amount, and Plan N leaves that cost with you. Plan G covers it in full.
Which states do not allow Part B excess charges?
Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont limit or prohibit them. Massachusetts, Minnesota, Ohio and Pennsylvania have broad bans; the others are narrower, and New York caps the charge at 5% rather than eliminating it.
Does the Plan N copay apply to lab work and x-rays?
No. The copay attaches to office visits, including specialist visits billed on office-visit codes. Standalone lab work, x-rays and durable medical equipment do not carry the copay.
Is the Plan N emergency room copay waived if I am admitted?
Yes. The emergency room copay of up to $50 is waived if the visit results in an inpatient admission. It is also a single charge, not stacked with an office visit copay.
Do I have to answer health questions to buy Plan G or Plan N?
Not during your six-month Medigap Open Enrollment Period, which begins when you are 65 or older and enrolled in Part B. During that window carriers must accept you regardless of health. Outside it, medical underwriting applies in most states unless you qualify for a guaranteed issue right.
Run your own numbers before you decide
Plan Match prices Plan G and Plan N side by side for your ZIP code, age and tobacco status. No Social Security number, no phone number to see rates.
Compare Plan G and Plan N in Plan Match Or talk it through: (828) 761-3326In North Carolina? See 2026 Plan G and Plan N pricing for NC — county rates, enrollment windows and a licensed local broker.
Sources
- CMS — 2026 Medicare Parts A & B Premiums and Deductibles
- CMS — Plan N copayment guidance
- Medicare.gov — Medigap plan benefits comparison
- Medicare.gov — 2026 Medicare costs fact sheet
Generation Health is a licensed insurance agency. We are not connected with or endorsed by the United States government or the federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week to get information on all of your options.
Robert Simm · Licensed Health Insurance Broker · NC #10447418 · Last reviewed August 2026.