Medigap Plan G vs. Plan N: Which Covers More of Your Bills?

If you've recently turned 65 or are shopping during an enrollment window, you've probably noticed that Medigap Plan G and Plan N dominate the market. Together they account for the majority of new Medigap enrollments in 2024 and 2025, and for good reason — both plans dramatically reduce the financial exposure that comes with Original Medicare alone. But they are not the same plan, and choosing the wrong one for your health situation can cost you real money over time.

Let's start with what both plans share. Plan G and Plan N both cover the Medicare Part A hospital coinsurance and all hospital costs up to an additional 365 days after Medicare benefits run out. Both cover the Part A deductible, which is $1,676 per benefit period in 2025. Both cover skilled nursing facility coinsurance, Part B coinsurance, and the first three pints of blood. Both also cover foreign travel emergency care at 80% after a $250 deductible, up to plan lifetime limits. These are substantial protections — without them, a serious hospitalization could expose you to thousands of dollars in cost-sharing under Original Medicare alone.

The differences between the two plans come down to three specific items: the Part B deductible, Part B excess charges, and office visit and emergency room copays. Plan G covers all three of these in full. Plan N does not cover Part B excess charges at all, and it requires you to pay up to $20 per office visit and up to $50 per emergency room visit (the ER copay is waived if you're admitted to the hospital). The Part B deductible — $257 in 2025 — is not covered by either Plan G or Plan N for anyone who became eligible for Medicare on or after January 1, 2020, due to federal rules that eliminated first-dollar coverage of the Part B deductible for new enrollees.

Part B excess charges deserve a closer look because many beneficiaries don't fully understand what they are. When a doctor or provider does not accept Medicare assignment — meaning they haven't agreed to accept Medicare's approved payment rate as full payment — they can legally charge up to 15% more than the Medicare-approved amount. That extra 15% is called an excess charge, and it comes entirely out of your pocket if you have Plan N. For example, if Medicare approves $200 for a specialist visit and your doctor charges $230, Plan N leaves you responsible for that $30 difference. Plan G pays it for you. In states like Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, laws either prohibit or significantly limit excess charges, which reduces the practical value of Plan G's excess charge coverage in those states. If you live in one of those states, Plan N becomes a more competitive option because one of Plan G's key advantages essentially disappears.

The premium difference between Plan G and Plan N is where the math gets interesting. In most markets in 2025, Plan N premiums run roughly $20 to $50 per month less than Plan G premiums for the same age and gender. That translates to $240 to $600 per year in premium savings if you choose Plan N. Whether those savings hold up depends entirely on how often you use medical services. If you see your primary care doctor four times a year and a specialist twice, you could pay up to $120 in Plan N office visit copays annually — still well below the premium savings in most cases. But if you're managing multiple chronic conditions and visiting doctors eight, ten, or twelve times a year, those copays start to erode the premium advantage quickly. A useful rule of thumb: if you expect to pay more in Plan N copays and excess charges than the annual premium difference between the two plans, Plan G is likely the better financial choice.

Premium pricing also varies significantly by insurance company, your age, your gender, your tobacco use status, and the pricing method the insurer uses. There are three pricing structures allowed for Medigap plans: community-rated (everyone pays the same regardless of age), issue-age-rated (your premium is based on your age when you buy the policy and doesn't automatically increase as you get older), and attained-age-rated (your premium increases as you age, which is the most common structure). An attained-age-rated Plan N might start cheaper than a community-rated Plan G, but over a decade the attained-age plan could become significantly more expensive. When comparing quotes, always ask the insurer which pricing method they use — it matters enormously for your long-term costs.

Timing your enrollment is critical because Medigap plans are medically underwritten in most states outside of specific guaranteed-issue windows. Your best opportunity to enroll in either Plan G or Plan N without answering health questions is during your Medigap Open Enrollment Period, which is the six-month window that begins the month you turn 65 and are enrolled in Medicare Part B. During this window, no insurer can deny you coverage or charge you more based on pre-existing conditions. Outside this window, insurers in most states can reject your application or charge higher premiums based on your health history. If you're already past your open enrollment window and want to switch plans, you may face underwriting — unless you qualify for a Special Enrollment Period due to a qualifying event like losing employer coverage.

Several states offer additional protections worth knowing about. If you live in California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, or Oregon, you have what's called a birthday rule — a 30-day window each year around your birthday during which you can switch to a Medigap plan with equal or lesser benefits without medical underwriting. This means if you're currently in Plan G and want to try Plan N, or vice versa, your birthday window may give you a no-questions-asked opportunity to make that switch. New York and Connecticut go further, offering guaranteed issue rights year-round regardless of health status.

One practical step that many beneficiaries skip: use Medicare's Plan Finder tool at Medicare.gov to compare standardized plan benefits side by side, then get quotes from multiple insurers for both Plan G and Plan N in your ZIP code. Premiums for identical coverage can vary by 40% or more between insurers in the same market. Organizations like the State Health Insurance Assistance Program (SHIP) — available in every state at no cost — can walk you through a personalized comparison based on your actual health usage and local insurer options. To find your local SHIP counselor, visit shiphelp.org or call 1-800-MEDICARE.