Medicare Plan G vs. Plan N in 2026: Which One Is Actually Worth It?

By Paul Barrett, Principal Agent, The Modern Medicare Agency | Updated June 2026

The Most Common Question I Get — and the Honest Answer Most People Never Hear

“Paul, should I go with Plan G or Plan N?”

After 18 years in Medicare, I hear this constantly. And I understand why — it looks like a simple choice between two similar plans, and the premium savings from Plan N can feel immediately compelling. Save $40, $50, even $60 a month? That adds up to real money.

But here’s the truth most comparison articles won’t say plainly: the right answer depends entirely on your specific situation, and the math only points one way when you actually run it for your circumstances. For many people, Plan N genuinely wins. For others, Plan G is clearly the better choice. And for a third group — one most agents skip over entirely — High Deductible Plan G is the smartest option of all.

I’m going to give you the real numbers, the genuine tradeoffs, and a framework to figure out which belongs in your situation. No soft-pedaling, no affiliate-driven “both are great!” conclusions. Just the honest math and 18 years of experience watching both go right and both go wrong.

One thing before we start: I earn a commission regardless of which plan you choose. My commission on some plans is actually higher than on others — but that never changes my recommendation. If Plan N is right for you, I’ll tell you Plan N. If HD Plan G makes the most sense, I’ll tell you that even though it pays the lowest commission. That’s the only way to do this work honestly.

Quick Answer: “Plan G averages $220/month nationally; Plan N averages $171/month — a $49 gap. Plan N wins financially for most healthy enrollees in states that ban excess charges (OH, PA, RI, VT, MA) or limit them (NY). Plan G is the better choice for frequent users, travelers, or anyone in states without guaranteed issue protections. HD Plan G ($50-91/month, $2,950 deductible) is the most underused option for healthy enrollees with savings to self-fund the deductible risk.”

What Makes These Plans Identical

Before we get to the differences, here’s what Plan G and Plan N share — and it’s substantial. Both cover:

✓ Part A hospital coinsurance, including up to 365 additional days after Medicare benefits are exhausted ✓ Part A deductible ($1,736 per benefit period in 2026) ✓ Skilled nursing facility coinsurance (days 21-100, up to $217.50/day in 2026) ✓ Part A hospice care coinsurance ✓ First three pints of blood ✓ Part B coinsurance (the 20% Medicare doesn’t pay) — with a small copay difference explained below ✓ Foreign travel emergency coverage (80% up to $50,000 lifetime maximum after a $250 deductible) ✓ Access to any doctor or hospital in the U.S. that accepts Medicare — no networks, no referrals

That’s enormous shared coverage. The differences are narrower than most people realize — but in specific situations, they matter a great deal.

Source: Medicare.gov: Compare Medigap Plan Benefits; CMS 2026 Medicare Costs

The Three Differences — Explained Precisely

Difference 1: The Part B Annual Deductible

Neither Plan G nor Plan N covers the Medicare Part B annual deductible. In 2026, that deductible is $283.

Both plans are identical here. You pay the $283 before either plan kicks in for Part B services. This is a wash.

Source: CMS 2026 Medicare Costs

Difference 2: The Plan N Copays

Under Plan N, you pay:

• Up to $20 copay for certain office visits
• Up to $50 copay for emergency room visits that do not result in inpatient admission (if you’re admitted, the $50 copay is waived)

Under Plan G, you pay $0 for both after your Part B deductible is met.

A few important clarifications that most articles get wrong or leave vague:

Not every visit triggers the $20 copay. Medicare Annual Wellness Visits, preventive care visits, and many lab-only visits do not trigger a Plan N copay. The copay applies to certain office visits billed under specific evaluation and management codes. Telehealth visits in many cases also do not trigger the copay. Your actual average annual copay exposure under Plan N is typically lower than a simple multiplication of visits × $20 would suggest.

The $50 ER copay is not a hidden deductible. If you arrive at the ER and are admitted to the hospital, the copay is waived entirely. The copay only applies to ER visits that result in outpatient treatment and discharge.

Difference 3: Part B Excess Charges — The One That Requires the Most Nuance

Plan G covers Part B excess charges in full. Plan N does not cover them at all.

What is a Part B excess charge? When a doctor accepts Medicare but declines Medicare “assignment” — meaning they don’t agree to accept Medicare’s approved rate as full payment — they can charge up to 15% more than the Medicare-approved amount. That extra amount is the excess charge. With Plan N, you pay it out of pocket. With Plan G, it’s covered.

How often does this actually happen nationally?

According to MedigapSeminars.org’s analysis of CMS data, more than 98% of medical doctors billing Medicare are participating providers who accept assignment and therefore cannot charge excess charges. The national rate of providers actually billing excess charges is under 2% — and of that group, a significant proportion are mental health providers, solo practitioners, and certain specialists in high-cost urban markets.

The average excess charge when it does occur is modest — typically a small percentage above a service that Medicare has already priced. On a $300 Medicare-approved service, the maximum excess charge is $45 (15% of $300). In practice, most non-participating providers charge less than the maximum.

The eight-state factor — and critical nuances:

Eight states have enacted laws limiting or prohibiting Part B excess charges: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

However — and this matters significantly — these state protections are not uniform, and several have important limitations that most articles gloss over:

Connecticut: CT doesn’t allow Part B excess charges for participants enrolled in the QMB program but does allow excess charges for other participants. Standard Medigap enrollees in Connecticut who are not in the QMB program can still face excess charges.

New York: New York State law limits the amount that Medicare non-participating providers may charge to no more than 5% above Medicare’s approved amount. This limit applies to all services except certain home and office visits for basic medical examinations billed under procedure codes 99201-99215 and 99341-99353, for which the federal limit of 15% applies. New York doesn’t fully ban excess charges — it limits most of them to 5% rather than the federal maximum of 15%.

Minnesota: MN does not allow Part B excess charges for its own citizens, but providers may charge excess fees to those coming from other states to use Minnesota facilities, such as the Mayo Clinic.

The practical bottom line on excess charges:

• If you live in OH, PA, RI, VT, or MA: excess charges are effectively banned for in-state care. The Plan G vs. Plan N excess charge difference is largely irrelevant — factor it out of your decision.
• If you live in NY: excess charges are limited to 5% (not 15%) for most services. Still real but materially reduced compared to other states.
• If you live in CT: the protection applies only to QMB enrollees. Standard Medigap holders should still consider their doctor assignment status.
• If you live in any other state: excess charges are possible but rare. The relevant question is whether your specific providers accept assignment — easily verified at Medicare Care Compare.
• Important regardless of state: If you travel frequently or live part of the year in a different state, your home state’s excess charge protections do not apply to out-of-state care. Plan N holders who snowbird or travel regularly face excess charge exposure in states that allow them, even if their home state doesn’t.

Source: Humana: Medicare Part B Excess Charges; NY HIICAP Notebook 2026; NerdWallet: Medicare Excess Charges; MedigapSeminars.org: What Are Medicare Part B Excess Charges?

The Premium Difference: What You Actually Save with Plan N

Here are the 2026 national averages based on available market data:

Source: MoneyGeek: Medigap Plan N vs. Plan G

Critical context before you use these numbers:

These are national averages. Your actual premium depends on your state, ZIP code, age, gender, tobacco use, and pricing model. The premium gap between Plan G and Plan N varies enormously by market:

• In some states, the gap is under $20/month — making Plan G easy to justify
• In others, the gap exceeds $70/month — making Plan N’s premium savings very compelling
• In New York specifically, both Plan G (~$372/month) and Plan N run significantly higher than national averages due to community rating and guaranteed issue requirements
• Premiums for the same plan can vary by 50% or more between carriers offering coverage in the same ZIP code

Always get actual quotes for your specific location before making this decision. National averages are a starting point, not your answer.

Source: The Big 65: Medicare Supplement Plan N Guide; paulbinsurance.com carrier data

The Math That Actually Matters: Three Real Scenarios

This is the section most comparison articles skip entirely. Let’s run the actual numbers using a $49/month premium gap ($588/year savings with Plan N) — the national average difference.

Scenario A: The Light User

Profile: Healthy 65-year-old, 3-4 routine doctor visits per year, no ER visits, no hospitalizations

With Plan N:

• Part B deductible: $283
• 3 office visit copays × $15 average (not all visits trigger the full $20): $45
• Annual medical out-of-pocket beyond premium: $328
• Annual premium savings vs. Plan G: $588
• Net annual advantage of Plan N: $260

With Plan G:

• Part B deductible: $283
• All other costs: $0
• Annual medical out-of-pocket beyond premium: $283
• Annual premium paid: $588 more than Plan N
• Net annual disadvantage vs. Plan N: $305

Verdict: Plan N clearly wins. The premium savings more than offset the copay exposure. Even in a year with 6 visits, Plan N still wins.

Scenario B: The Moderate User

Profile: 70-year-old managing blood pressure and cholesterol, 8-10 doctor/specialist visits per year, one ER visit (not admitted)

With Plan N:

• Part B deductible: $283
• 9 office visit copays × $18 average: $162
• 1 ER copay (not admitted): $50
• Annual out-of-pocket beyond premium: $495
• Annual premium savings vs. Plan G: $588
• Net annual advantage of Plan N: $93

With Plan G:

• Part B deductible: $283
• All other costs: $0
• Annual out-of-pocket beyond premium: $283
• Annual premium paid: $588 more than Plan N
• Net annual disadvantage vs. Plan N: $93

Verdict: Plan N still edges out Plan G, though the margin narrows significantly. At a smaller premium gap ($30/month), this scenario essentially breaks even. At a larger gap ($70/month), Plan N wins more decisively.

The Break-Even Formula from MedigapSeminars.org: Take your monthly premium savings and divide by $20 (the max office copay). That tells you how many full-copay visits per month it would take before Plan N stops being the better value. If you save $50/month, you’d need 2.5 copay-triggering visits per month (30 per year) before Plan G matches Plan N on total cost. Most moderate users don’t reach that threshold.

Source: MedigapSeminars.org: Plan N vs. Plan G

Scenario C: The Heavy User

Profile: 74-year-old with cardiac condition, 18-20 specialist visits per year including cardiology, one ER visit, one brief hospitalization

With Plan N:

• Part B deductible: $283
• 18 specialist/office copays × $20: $360
• 1 ER copay (not admitted): $50
• Annual out-of-pocket beyond premium: $693
• Annual premium savings vs. Plan G: $588
• Net annual disadvantage vs. Plan N: $105 (Plan G is now cheaper)

With Plan G:

• Part B deductible: $283
• All other costs including hospital: $0
• Annual out-of-pocket beyond premium: $283
• Plan G advantage: $105/year — plus predictability

Verdict: Plan G wins for heavy users, and the advantage compounds with peace of mind. A patient managing a serious condition who sees specialists regularly may find that Plan G’s copay elimination significantly reduces both financial and psychological friction.

Add potential excess charge exposure: If this heavy user is in a state that allows excess charges and sees a non-participating specialist, the exposure adds to Plan N’s cost disadvantage. In states where excess charges are effectively banned (OH, PA, RI, VT, MA), this factor disappears — making Plan N more competitive even for heavier users.

High Deductible Plan G: The Third Option That Changes Everything

Here is where most comparison articles stop, and it’s exactly the wrong place to stop.

High Deductible Plan G (HD Plan G) is structurally identical to standard Plan G — same benefits, same nationwide access, same coverage for every Medicare-approved service. The only difference: you must meet an annual deductible ($2,950 in 2026) before the plan pays. After you hit that deductible, it functions exactly like standard Plan G — full coverage for all Medicare-approved costs for the rest of the year.

In exchange for accepting that deductible, the premium is dramatically lower:

Wait — the worst-case scenario for HD Plan G ($4,042) is actually higher than for standard Plan G ($2,923). Doesn’t that mean HD Plan G is riskier?

Yes, in the worst case. But look at what happens in a healthy year:

Healthy year with HD Plan G at $75/month:

• Annual premium: $900
• Out-of-pocket (light user): $283-$600
• Total: $1,183-$1,500 — potentially $1,000-$1,500 LESS than standard Plan G

Over 5 years of generally good health, the cumulative premium savings from HD Plan G vs. standard Plan G can easily exceed $6,000-$8,000. That’s a meaningful financial cushion — and it can serve as a self-funded reserve against the years when you do use more healthcare.

HD Plan G is right for you if:

• You are in generally good health with no chronic conditions requiring frequent specialist visits
• You have savings to comfortably absorb a $2,950 expense in a high-use year without financial stress
• You understand and are comfortable with the “pay as you go up to the deductible, then full coverage” structure
• You’re disciplined enough to set aside the premium difference as a health savings reserve

HD Plan G is probably not right for you if:

• You see multiple specialists regularly and anticipate consistent high healthcare use
• A $2,950 bill in a single year would cause real financial stress
• You want absolute cost predictability above all other factors
• You live in a state with very few HD Plan G carrier options

One important caveat: The HD Plan G deductible increases annually based on the Consumer Price Index. The CMS-confirmed history: $2,370 in 2021, $2,490 in 2022, rising to $2,870 in 2025 and $2,950 in 2026 — a 24% increase over five years. It will continue rising each year. Factor that trajectory into your long-term planning, not just the 2026 figure.

Source: Boomer Benefits: High Deductible Plan G; 65Medicare.org: HD Plan G Considerations and Cautions

The Switching Trap: Why This Decision Is Stickier Than It Looks

This section is critical and almost never covered adequately in Plan G vs. Plan N comparison articles.

When you first enroll in Medicare and choose a Medigap plan, you are in your 6-month Open Enrollment Period — during which any carrier must accept you for any plan at standard rates, no health questions asked. This is the most consumer-friendly enrollment window in all of Medicare, and it’s one-time only.

After it closes, switching Medigap plans in most states requires medical underwriting. The carrier can ask health questions, deny your application, or charge a higher premium based on your health history.

The practical consequence for Plan N enrollees: if you choose Plan N at 65, stay in it for five years, develop a cardiac condition, and then want to upgrade to Plan G — in most states, you may not be able to. The carrier can decline to cover you. You chose Plan N when you were healthy and find yourself unable to upgrade when your health needs increase.

State-level exceptions to this rule:

• New York, Connecticut, Vermont, Washington: Year-round guaranteed issue. You can switch between Plan G and Plan N (or any other plan) at any time without underwriting. For New Yorkers, this makes the initial choice between Plan G and Plan N somewhat less permanent — though the NY community-rated market still has limited carrier competition.
• 16 birthday rule states: Annual window around your birthday to switch to a plan of equal or lesser benefits without underwriting. California, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Rhode Island, Delaware, Virginia, West Virginia, Wyoming, and Missouri (anniversary rule) all have some form of this protection.
• MA trial right: If you move from Medigap to Medicare Advantage for the first time, you have 12 months to return to Medigap without underwriting.

If you’re in a state without guaranteed issue or birthday rule protections, and you believe your health may change significantly in the next several years — the initial choice between Plan G and Plan N carries more long-term weight than the monthly premium math alone suggests.

Source: KFF: Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions; The Big 65: Birthday Rule State Guide

Who Should Choose Plan G

Plan G is the right choice when:

• You see specialists frequently (more than 10-12 visits per year) and the copay math tips against Plan N
• You have a chronic condition with predictable, ongoing healthcare needs
• You live in a state that allows excess charges and your doctors include non-participating providers
• You travel frequently or live part of the year in another state where excess charge protections don’t follow you
• You are in a state without guaranteed issue or birthday rule protections and you’re concerned about your ability to switch plans if your health declines
• Cost certainty is paramount to your sense of financial security — some people find the unpredictability of copays genuinely stressful regardless of the math
• You’re 70+ and your health trajectory suggests increasing care needs where Plan G’s coverage advantage compounds

Who Should Choose Plan N

Plan N is the right choice when:

• You are in good to excellent health with relatively few routine care visits per year
• You live in one of the states where excess charges are effectively banned — OH, PA, RI, VT, MA — or where they’re substantially limited (NY)
• All your current providers accept Medicare assignment (easily verified in 5 minutes at Medicare Care Compare)
• You live in a guaranteed issue state (NY, CT, VT) or a birthday rule state where you have a protected annual window to upgrade if your health changes
• The premium gap in your market is substantial ($50+/month) — at that savings level, the math strongly favors Plan N in most usage scenarios
• You are comfortable with known, modest copays in exchange for meaningfully lower monthly costs

Paul’s Bottom Line: Here’s What I Actually Tell My New York Clients

Since the majority of my clients are in New York, and because NY has unique rules, I want to be specific about what I recommend in this market.

In New York, Plan N deserves serious consideration for most healthy new enrollees — and here’s why:

1. The premium gap between Plan G (~$372/month) and Plan N in NY is meaningful, often $50-80/month or more
2. NY limits excess charges to 5% (not 15%) for most services — reducing the Plan G excess charge advantage substantially
3. NY’s year-round guaranteed issue means you can switch between plans at any time if your health changes — removing the “stuck forever” risk that makes the initial choice feel permanent in other states
4. All that said: if you see specialists very frequently or have an active condition requiring regular care, Plan G’s premium is buying real coverage value

For clients outside New York in states without guaranteed issue protections, I’m more cautious about Plan N — not because Plan N is wrong, but because the switching trap is real. If your health changes and you want to upgrade, you may not be able to.

For the right client, HD Plan G is my most underutilized recommendation. It pays lower commission than both Plan G and Plan N, which is exactly why most agents don’t bring it up. But for a healthy 65-70-year-old with sufficient savings to absorb the deductible in a high-use year, the cumulative premium savings over 10 years can be substantial.

My honest summary:

• Plan N wins for most healthy enrollees in ban states or guaranteed-issue states
• Plan G wins for frequent users, travelers, and anyone in underwriting states concerned about their health trajectory
• HD Plan G wins for healthy enrollees who want maximum premium savings and can self-fund the deductible risk

The 6-Question Decision Framework

Work through these honestly. The answers will point you clearly in one direction.

1. How many copay-triggering visits do you realistically have each year? Divide your monthly premium gap by $20. That’s how many full-copay visits per month it takes for Plan N to break even with Plan G. Are you above or below that threshold?
2. Do you live in one of the states where excess charges are effectively banned? Ohio, Pennsylvania, Rhode Island, Vermont, Massachusetts: Plan N’s excess charge gap is largely irrelevant for in-state care. Connecticut: only for QMB enrollees. New York: limited to 5% for most services.
3. Have you verified whether your current doctors accept assignment? A 5-minute search at Medicare Care Compare answers this definitively. If all your providers accept assignment, Plan G’s excess charge protection has zero current value for you.
4. Do you live in a guaranteed issue or birthday rule state? If yes, the switching trap risk is reduced — your initial plan choice is less permanent. If no, consider whether your likely health trajectory over the next 10 years makes Plan G’s extra protection worth the premium.
5. Are you in good enough health to seriously consider HD Plan G? If you’re healthy, rarely need healthcare, and have savings to cover $2,950 in a high-use year — HD Plan G deserves to be in the conversation.
6. What is the actual premium gap in your specific ZIP code? National averages tell you nothing useful about your specific market. A $20/month gap makes Plan G very easy to justify. A $70/month gap makes Plan N very difficult to pass up. Get real quotes before deciding anything.

Want Me to Run the Numbers for Your Specific Situation?

The right answer for you depends on your health, your location, your doctors, your premium quotes, and your state’s switching rules. I can pull all of that together in a single conversation — at no cost, with zero obligation.

I’ll tell you honestly which plan makes sense for your situation, show you the math, and compare rates from the 40+ carriers I represent. If the answer is HD Plan G, I’ll tell you that even though it pays me less. If the answer is Medicare Advantage instead of any Medigap plan, I’ll tell you that too.

Paul Barrett | The Modern Medicare Agency 📞 (631) 358-5793 ✉️ medicare@paulbinsurance.com 🌐 paulbinsurance.com

Sources and Further Reading

• Medicare.gov: Compare Medigap Plan Benefits
• CMS 2026 Medicare Costs
• MoneyGeek: Medigap Plan N vs. Plan G 2026
• MedigapSeminars.org: Medicare Supplement Plan N vs. Plan G
• MedigapSeminars.org: What Are Medicare Part B Excess Charges?
• Humana: Medicare Part B Excess Charges Explained
• NerdWallet: Medicare Part B Excess Charges
• NY HIICAP Notebook 2026: Module 4 Medicare Part B
• Senior65: New York Medigap Rules You Need to Know
• Boomer Benefits: Plan G vs. Plan N
• Boomer Benefits: High Deductible Plan G
• The Big 65: Medicare Supplement Plan N Guide 2026
• The Big 65: Best Medicare Supplement Plans 2026
• 65Medicare.org: Medicare Part B Excess Charges
• 65Medicare.org: HD Plan G Considerations and Cautions
• KFF: Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions
• The Big 65: Medicare Birthday Rule State-by-State Guide
• Healthline: Medicare Plan G vs. Plan N
• Mutual of Omaha: Plan G vs. Plan N
• Medicare Care Compare: Provider Assignment Search
• paulbinsurance.com: Medigap Rate Increases 2026

Paul Barrett is the founder and Principal Agent of The Modern Medicare Agency. He has worked exclusively in Medicare for 18+ years, holds licenses in 34 states, and represents 40+ carriers. He is the author of Medicare Mastery Unlocked and hosts the Insurance Wise Guys Podcast. This article is for educational purposes only. Premium ranges are national averages and vary significantly by state, ZIP code, age, gender, tobacco use, and carrier. Excess charge state rules are subject to change — verify current rules with your state insurance department or a licensed independent broker. Contact a licensed Medicare broker for guidance specific to your situation.