Medigap Plan N: Lower Premiums, But Know the Trade-Offs

Medigap Plan N has quietly become one of the most popular Medicare Supplement options on the market, and it's easy to see why when you look at the premium savings. In 2025, a 65-year-old non-smoking woman in many parts of the country can find Plan N premiums starting around $90–$130 per month, compared to $140–$200 or more for Plan G. That gap — sometimes $50 to $70 per month — adds up to $600 to $840 in annual savings. But those savings come with real strings attached, and understanding exactly what you're giving up is the difference between a smart financial decision and an expensive surprise.

To understand Plan N, you first need to understand what it covers. Like Plan G, Plan N covers the Medicare Part A hospital deductible ($1,676 in 2025), Part A coinsurance and hospital costs, skilled nursing facility coinsurance, Part B coinsurance (with exceptions), foreign travel emergency care up to plan limits, and the first three pints of blood. What Plan N does NOT cover is the Medicare Part B deductible ($257 in 2025) — though neither does Plan G for anyone who became eligible for Medicare after January 1, 2020. The two critical gaps that separate Plan N from Plan G are copayments for certain office and emergency room visits, and the absence of coverage for Part B excess charges.

Here's how the copay structure works in practice. With Plan N, you may owe up to $20 for each office visit where Medicare Part B pays — this includes primary care and specialist visits. If you go to the emergency room but are not admitted as an inpatient, you may owe up to a $50 copay. These amounts are set by the plan, not by Medicare, so actual copays can vary slightly by insurer, but federal rules cap them at those maximums. For someone who sees their primary care doctor four times a year and one specialist twice a year, that's potentially $120 in copays annually — still well below the $600+ in premium savings. But if you're managing multiple chronic conditions and seeing several specialists regularly, those $20 copays can stack up quickly and erode the premium advantage.

The excess charge issue is where Plan N can really bite you, and it's the part most beneficiaries don't fully understand until they get a bill. Medicare sets an approved payment amount for every covered service. Doctors who accept Medicare assignment agree to accept that amount as payment in full. But doctors who do not accept assignment — called non-participating providers — can legally charge up to 15% more than the Medicare-approved rate. That extra 15% is called an excess charge, and Plan N does not cover it. Plan G does. So if you see a specialist who charges $500 for a procedure and Medicare approves $400, the excess charge is $60 (15% of $400). With Plan G, you pay nothing. With Plan N, you pay $60 out of pocket. In states with large urban medical centers and many independent specialists, excess charges are a real and recurring risk.

The good news is that excess charges are actually banned in several states. If you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, state law prohibits doctors from billing Medicare patients excess charges — which means the Plan N versus Plan G decision in those states becomes much simpler. In those markets, Plan N's only real downside is the office visit and ER copays, and the premium savings become much easier to justify. In states where excess charges are permitted and common — particularly in areas with many academic medical centers or concierge-style practices — Plan G's complete coverage may be worth the higher monthly cost.

Who is Plan N actually right for? The honest answer is: relatively healthy beneficiaries in their late 60s or early 70s who have a primary care doctor and perhaps one or two specialists, all of whom accept Medicare assignment. If you're in good health, rarely need specialist care, and live in a state where excess charges are either banned or uncommon in your area, Plan N can deliver genuine long-term savings. Over five years, the premium difference between Plan N and Plan G could easily total $3,000 to $4,000 — money that stays in your pocket rather than going to an insurance company for coverage you may never use. The calculus changes if you have a complex medical history, take multiple medications requiring frequent monitoring, or see specialists who operate outside the Medicare assignment system.

One important strategic consideration: Medigap plans are medically underwritten in most states, meaning insurers can charge you more or even deny coverage based on your health history — except during your guaranteed issue window. That window opens when you first enroll in Medicare Part B and lasts six months. During that window, any insurance company selling Medigap in your state must sell you any plan they offer at standard rates, regardless of your health. If you miss that window and want to switch plans later, you may face underwriting. This is why some financial advisors suggest starting with Plan G during the guaranteed issue period if you have any health concerns, then potentially switching to Plan N later if your health remains stable — though that switch would require underwriting in most states.

If you live in one of the 13 states with a birthday rule — California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, or Oregon — you have an annual 30-day window around your birthday to switch Medigap plans without medical underwriting. This is a significant consumer protection that makes Plan N a more flexible option in those states. You could theoretically start with Plan G, and if your health remains good and your finances tighten, use your birthday window to switch to Plan N without risking denial or higher rates due to health conditions.

When comparing Plan N quotes, use Medicare's official Plan Finder tool at medicare.gov or contact your State Health Insurance Assistance Program (SHIP) counselor — a free, unbiased resource available in every state. SHIP counselors can help you compare actual premium quotes from insurers in your area, explain how each plan's pricing method (community-rated, issue-age-rated, or attained-age-rated) affects your long-term costs, and walk through whether the doctors you currently see accept Medicare assignment. You can find your local SHIP program through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116. This kind of personalized guidance is especially valuable because Plan N premiums vary significantly by insurer, location, and age — a plan that's the best value at 65 may not be the best value at 75 if it uses attained-age pricing that rises steeply over time.