Medigap Plan G vs. Plan N: which should I pick?

Is the cheaper Medigap plan actually cheaper? Plan N costs less every month than Plan G, but it hands some risk back to you. Whether that trade is worth it comes down to one obscure billing rule most people have never heard of.

What Medigap does

Medigap, also called Medicare Supplement, fills the holes that Original Medicare leaves behind: the deductibles, the 20% coinsurance, the costs that otherwise have no ceiling. Plans are standardized by letter, so a Plan G from one insurer covers the same things as a Plan G from another. The only differences are price and service. Two plans dominate the market for new enrollees: G and N.

Where they differ

Plan G covers almost everything except the Part B deductible ($283 for 2026). After that, your covered costs are essentially zero. You pay a premium and you’re done.

Plan N covers most of the same ground but keeps three differences:

• A copay of up to $20 for office visits and up to $50 for emergency room trips.
• No coverage for the Part B deductible, same as G.
• No coverage for Part B “excess charges.”

That last one is the sleeper. An excess charge is when a doctor who doesn’t accept Medicare’s approved amount bills you up to 15% more. Plan G absorbs that charge. Plan N leaves it on you. In states that ban excess charges entirely, the risk is moot. In states that allow them, it’s a real and unpredictable cost.

How to actually choose

Run the math, then weigh the risk. Add up Plan N’s annual premium savings versus Plan G. Then ask how many doctor visits you realistically have in a year and whether your area allows excess charges. If you’re a frequent flyer at the doctor or you live somewhere excess charges are common, Plan G’s premium often buys real peace. If you’re healthy, rarely in an office, and in a state that bans excess charges, Plan N can be the smarter buy.

For most affluent retirees I work with, the deciding factor isn’t the copay. It’s whether they want to think about any of this at all. Plan G is the “set it and forget it” choice. You pay a bit more to never see a surprise bill.

The mistake that locks you in

Here’s the trap nobody warns you about. When you first enroll in Medigap, you get a guaranteed-issue window where insurers can’t reject you or charge you more for your health. Later, if you want to switch plans, you can be medically underwritten in most states, which means a health condition can price you out or shut you out.

So the choice between G and N isn’t only about this year’s premium. It’s about which plan you can comfortably keep for decades, because changing your mind later may not be free. Pick the plan you’d be happy holding at 85, not just the one that wins this month.