This article is educational and not insurance advice; all Medicare cost-sharing figures reflect the 2026 plan year as published by CMS, and premium figures reflect quotes collected for the 2026 plan year.
TL;DR — Quick Verdict
- Plan G and Plan N cover identical benefits except three items: Part B excess charges, office visit copayments, and emergency room copayments.
- Plan G averages $220 per month at age 65 across the 2026 plan year; Plan N typically prices $30 to $50 per month below Plan G in the same market, producing $360 to $600 in annual premium savings.
- Plan N charges up to $20 per applicable office visit and up to $50 per emergency room visit that does not result in inpatient admission. Both plans leave the $283 Part B deductible to the beneficiary.
- Break-even math: at a $40 monthly premium gap, a Plan N enrollee must absorb 24 copayable office visits per year before Plan G wins on cost.
- Recommendation: Plan N for beneficiaries under 15 annual office visits whose providers accept Medicare assignment; Plan G for high-utilizers, frequent ER users, and anyone in a state where excess charges are permitted and specialists commonly bill them.
The Centers for Medicare & Medicaid Services set the 2026 Part B annual deductible at $283 and the Part A inpatient hospital deductible at $1,736 — and neither Medigap Plan G nor Plan N pays the Part B portion for you. That is where the similarity ends and the pricing divergence begins. Two federally standardized plans, sold by the same carriers under the same benefit rules, can cost a 65-year-old in the same ZIP code a difference of $600 a year. Mutual of Omaha, Aetna, Cigna, and UnitedHealthcare/AARP all sell both letters, and all four price Plan N below Plan G.
The problem is that the premium gap is visible and the cost-sharing gap is not. Shoppers see $40 a month and enroll. What they cannot see is how many copayable visits they will generate, whether their cardiologist bills excess charges, or how attained-age rating will widen the gap by age 78. This analysis models the break-even point in visits, prices out four utilization scenarios against verified 2026 CMS cost-sharing figures, and identifies the specific beneficiary profiles where each letter wins.
What Plan G and Plan N Actually Cover in 2026
Federal standardization means a Plan G sold in Ohio is benefit-identical to a Plan G sold in Arizona. Carriers compete on price and service, not coverage. Both letters pay Part A coinsurance and hospital costs for an additional 365 days beyond Medicare’s limit, the full $1,736 Part A deductible and benefit period gaps, skilled nursing facility coinsurance, the first three pints of blood, hospice coinsurance, and foreign travel emergency care at 80% after a separate deductible.
Three differences separate them. Plan G pays Part B excess charges; Plan N does not. Plan N imposes a copayment of up to $20 on certain office visits and up to $50 on emergency room visits not resulting in admission; Plan G imposes none. Neither plan covers the $283 Part B deductible — a 2020 statutory change eliminated first-dollar Part B coverage for anyone newly eligible on or after January 1, 2020, which is also why Plan F is closed to that cohort.
Cost-sharing amounts from the Centers for Medicare & Medicaid Services 2026 Parts A & B premiums and deductibles fact sheet and the Federal Register Part B rate notice for 2026. Plan benefit structure is federally standardized under 42 U.S.C. §1395ss.
2026 Premium Data: What Each Plan Actually Costs
MoneyGeek collected 16,954 Medigap quotes from Medicare.gov across all states in November 2025 for the 2026 plan year. That dataset puts the all-plan average at $189 per month at age 65, rising to $238 at age 75 — roughly $600 more per year purely from attained-age rating. Plan G specifically averages $220 per month at age 65, making it the most expensive of the three plans open to new enrollees.
Plan N pricing is harder to pin to a single national point figure because carrier filings vary more widely at the lower end. Across state-level market surveys for 2026, Plan N consistently prices $20 to $50 per month below Plan G in the same market — Texas market surveys, for example, show Plan G at $130 to $250 and Plan N at $95 to $175. Treat $30 to $50 as the planning range for the gap and verify with a same-carrier quote, since cross-carrier comparisons distort the spread.
Premium averages from MoneyGeek’s November 2025 collection of 16,954 Medicare.gov quotes for the 2026 plan year; Part B premium from the Centers for Medicare & Medicaid Services (verify at cms.gov). Plan N discount stated as a defensible range — carrier-specific national Plan N point averages were unavailable from a primary source for this period.
One figure gets omitted from nearly every comparison: the $202.90 standard Part B premium applies regardless of which letter you buy, and rises sharply under income-related adjustment. Higher earners should model the IRMAA surcharge rules and reduction requests before assuming the Medigap premium is their largest monthly line item.
The Break-Even Calculation Nobody Runs
Premium savings are certain. Copayments are probabilistic. The break-even point is the annual visit count at which Plan N’s copayments consume the entire premium advantage.
Start with the formula: break-even visits = (monthly premium gap × 12) ÷ $20 copayment. At a $30 gap, that is $360 ÷ $20, or 18 copayable office visits per year. At a $40 gap: $480 ÷ $20 = 24 visits. At a $50 gap: $600 ÷ $20 = 30 visits.
Consider Margaret, 68, in a market where Plan G quotes $215 and Plan N quotes $175 — a $40 gap, $480 annually. She sees her internist twice, a rheumatologist quarterly, and a dermatologist annually: seven copayable visits. Her copayment exposure is $140. Both plans leave her the $283 Part B deductible, so that cancels out of the comparison entirely. Margaret nets $340 ahead on Plan N.
Now change one variable. Margaret has one ER visit for chest pain and is sent home after observation — no inpatient admission, so the copayment applies at up to $50. Her total becomes $190. She is still $290 ahead. It takes an implausible pattern of utilization to flip this. Where the math actually breaks is not visit volume but excess charges, which are uncapped in annual aggregate.
Original modeling by Real Cost Report. Copayment maximums per federally standardized Plan N benefit design; premium gap held at $40/month. The $283 Part B deductible is excluded because both plans leave it to the beneficiary. Modeled, not measured.
Plan G vs Plan N: Which Is Better for a Newly Eligible 65-Year-Old?
Excess charges decide this comparison far more often than copayments do. A provider who does not accept Medicare assignment may bill up to 15% above the Medicare-approved amount. Plan G absorbs that. Plan N sends the bill to you, and there is no annual ceiling on the aggregate.
Geography narrows the risk substantially. Several states — including Ohio, Connecticut, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, and Vermont — prohibit excess charges outright. In those markets, Plan G’s excess-charge coverage protects against something that legally cannot happen, which makes the premium differential close to pure waste.
Outside those states, the exposure is real but concentrated. The overwhelming majority of participating providers accept assignment, and the risk clusters in specific specialties and in concierge or out-of-network arrangements. Beneficiaries with an established care team can eliminate the variable with a single phone call to each provider’s billing office asking whether they accept Medicare assignment.
Verdict
Plan N wins for the newly eligible 65-year-old in an excess-charge-prohibited state, or in any state where every current provider accepts Medicare assignment. The $360 to $600 annual premium savings survives typical utilization by a wide margin, and the copayment exposure is bounded and predictable. Plan G wins where a beneficiary has an unstable provider roster, travels frequently to out-of-network care, expects to use emergency departments repeatedly without admission, or simply places a high value on eliminating billing variability. Plan G’s real advantage is not expected cost — it is variance reduction, and variance reduction has a price of roughly $40 a month.
What Most People Get Wrong
Four errors account for most regret in this decision, and three of them are irreversible after the six-month Medigap open enrollment window closes.
Mistake 1: Assuming you can switch letters later. Guaranteed issue applies during the six-month period beginning when you are 65 and enrolled in Part B. After that, most states permit medical underwriting on Medigap applications. A Plan N enrollee who develops a chronic condition and then tries to move to Plan G can be declined outright. Correct action: if your health trajectory is uncertain and you can afford Plan G, buy the coverage you may not be able to qualify for later. Verify your state’s rules on annual enrollment switching rules — roughly fifteen states operate birthday or anniversary rules that permit switching without underwriting.
Mistake 2: Comparing Plan G from one carrier against Plan N from another. Carrier pricing philosophy varies by 30% to 50% within the same state. Comparing across carriers measures underwriting appetite, not plan design. Correct action: pull both letters from the same three carriers and compare the intra-carrier gap.
Mistake 3: Ignoring the rating method. Attained-age policies look cheap at 65 and climb every birthday; community-rated policies cost more initially and hold flat. Over a 20-year horizon the ranking frequently inverts. Correct action: ask which method the carrier filed before comparing quotes — the Medigap premium rating methods compared analysis walks through the crossover math.
Mistake 4: Treating Medigap as the whole decision. Neither letter includes prescription drug coverage, and neither covers routine dental, vision, or hearing. A complete Medigap-path budget requires a standalone drug plan; skipping it triggers a permanent late enrollment penalty. Model Part D plan selection and formulary comparison alongside the supplement, and understand the dental, vision, and hearing exclusions before assuming you are fully covered.
Who Should Choose Each Plan
Utilization patterns, provider stability, and risk tolerance drive this. Income does not — both letters cost the same regardless of what you earn, though your Part B premium does not.
Choose Plan N if you generate fewer than 15 copayable office visits annually, every current provider accepts Medicare assignment, you live in a state prohibiting excess charges, you rarely use emergency departments, and you would rather bank $400 a year than eliminate small unpredictable bills. Plan N also suits beneficiaries who are cost-sensitive but unwilling to accept the network restrictions and prior authorization requirements that come with Medicare Advantage.
Choose Plan G if you have a chronic condition driving frequent specialist contact, you split time between states or travel often, you use concierge or out-of-network specialists who may bill excess charges, or you have a history of ER visits that resolve without admission. Plan G is also the defensible choice for anyone managing care on behalf of a parent, where predictable billing matters more than optimizing $40 a month.
Choose neither if the combined Medigap and Part D premium exceeds what your budget tolerates. That is the point to run a full Medigap vs Medicare Advantage annual cost comparison, weighing the supplement’s provider freedom against Advantage’s capped exposure through the Advantage out-of-pocket maximum coverage. Beneficiaries still working past 65 should separately confirm how Medicare coordination with employer coverage affects the timing of their open enrollment window, since enrolling in Part B early can waste the guaranteed-issue period entirely.
Frequently Asked Questions
Does Plan N cover the Part B deductible?
No. Neither Plan N nor Plan G covers the Part B deductible, which the Centers for Medicare & Medicaid Services set at $283 for 2026. You pay that amount out of pocket each calendar year before either plan’s Part B coinsurance coverage begins. Because both letters treat it identically, the deductible cancels out of any Plan G versus Plan N cost comparison and should not influence the decision.
Is the Plan N office copayment always $20?
No — $20 is a ceiling, not a flat charge. The copayment equals the lesser of $20 or the Part B coinsurance that would otherwise apply, so lower-cost visits generate lower copayments. Coding also determines applicability: Medicare-covered preventive services, including the annual wellness visit, carry no copayment. The ER copayment of up to $50 applies only when the visit does not result in inpatient admission.
How large can Part B excess charges get?
A non-participating provider may bill up to 15% above the Medicare-approved amount. There is no annual cap on the aggregate, which is what makes this Plan N’s genuine risk rather than the copayments. Several states prohibit excess charges entirely, including Ohio, Connecticut, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, and Vermont. Confirm your state’s rule with its department of insurance before pricing this risk.
Can I switch from Plan N to Plan G later?
You can apply year-round, but outside the six-month Medigap open enrollment period most states permit medical underwriting, meaning the carrier can decline you. Approximately fifteen states operate birthday or anniversary rules allowing a switch to equal or lesser coverage without underwriting. Missing your initial window also risks the separate Part B late enrollment penalty, which is permanent — review enrollment deadlines and late penalty costs before delaying.
How We Researched This Article
Cost-sharing figures — the $283 Part B annual deductible, the $202.90 standard Part B monthly premium, the $1,736 Part A inpatient hospital deductible, and the $217 daily skilled nursing facility coinsurance for days 21 through 100 — were taken from the Centers for Medicare & Medicaid Services 2026 Parts A & B premiums and deductibles fact sheet, published November 14, 2025, and cross-checked against the Federal Register notice establishing Part B actuarial rates for the period beginning January 1, 2026. Where the fact sheet and the Federal Register notice were consistent, we cited the figure without a range. Plan benefit standardization follows federal law under 42 U.S.C. §1395ss; benefit descriptions were verified against Medicare.gov’s Medigap documentation and the Part A and B coverage rules published by the Centers for Medicare & Medicaid Services.
Premium figures present a different evidentiary problem. No federal agency publishes a national Medigap premium average, because Medigap is a private product regulated at the state level and rate filings sit with individual state insurance departments. We therefore used the largest publicly documented quote collection available: MoneyGeek’s November 2025 dataset of 16,954 quotes pulled from the Medicare.gov plan finder across all states for the 2026 plan year. That source supports the $189 all-plan average at age 65, the $238 average at age 75, the $220 Plan G average, and the $61 high-deductible Plan G average with its $2,950 out-of-pocket threshold. A comparable single-point national average for Plan N was not available from any primary source, so we applied Fallback Option A and reported the Plan G to Plan N differential as a $30 to $50 monthly range drawn from state-level market surveys, noting the limitation explicitly in the premium table caption.
All break-even calculations and the four-scenario cost model are original modeling by Real Cost Report, built on the verified 2026 cost-sharing amounts and a held-constant $40 monthly premium differential. They are modeled projections, not measured outcomes, and they exclude Part D premiums, IRMAA surcharges, and services outside Parts A and B. Individual results will vary with visit coding, provider assignment status, state excess-charge law, and carrier rating method. Research was last conducted July 2026. All figures were verified against named primary sources before publication.