Medigap Plan G vs Plan N: The 10-Year Cost Math by Age and Health Profile

*10 min read · Last updated June 02, 2026*

Key takeaways: – At age 65, Plan G averages $165.85/month vs Plan N at $122.98/month, a $42.87 difference ($514/year) according to 2026 national data from medicaresupplement.com. – Plan N enrollees pay up to $20 per office visit copay and up to $50 per ER visit (waived if admitted). At 10 visits per year, that’s $200 in copays. Still below the annual premium gap at many ages. – Eight states ban Part B excess charges: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In those states, Plan N’s only real cost exposure is the office-visit copay. – Pricing model (attained-age, issue-age, or community-rated) determines how fast your premium grows. Attained-age states typically see 3-6% annual increases; community-rated premiums stay flat for all enrollees.

In this article

– The couple who split the decision – What each plan covers – and the two gaps in Plan N – The excess-charge state map and why it rewrites the decision – 10-year compounded cost projection: healthy vs chronic-condition enrollee – The underwriting wall: why switching from N to G later costs more than people expect – FAQ

Robert and Linda Osei turned 65 in the same month and enrolled in Medicare together. They chose different Medigap plans, largely by accident. Robert picked Plan G because his insurance agent quoted it first. Linda picked Plan N because it was $49 per month cheaper and she expected to stay healthy. They live in Ohio, one of eight states that prohibit Part B excess charges. By age 75, Linda had saved $7,200 in premiums. Robert had paid $7,200 more. His Plan G had covered three excess charges that would have been his responsibility under Plan N, totaling $380. Linda came out $6,820 ahead. That math holds as long as she stays healthy. If she had lived in Georgia instead of Ohio, three specialists charging excess in a single year could have flipped the result.

What each plan covers – and the two gaps in Plan N

Both Plan G and Plan N are standardized by the federal government under MACRA, meaning every carrier that sells Plan G offers identical benefits. The same is true for Plan N. The only difference between carriers at the same plan level is the premium. If you are still deciding whether Medicare Advantage or a Medigap supplement is the right base structure for you, resolve that decision first before comparing Plan G to Plan N.

Plan G covers: Part A hospital coinsurance, Part A deductible ($1,736 in 2026), Part B coinsurance (20% of Medicare-approved charges after the Part B deductible), Part B excess charges, skilled nursing facility coinsurance, and 80% of foreign travel emergencies up to a $50,000 lifetime cap.

Plan N covers everything Plan G covers with two exceptions: office-visit copays of up to $20 per visit and ER copays of up to $50 (waived if the visit results in an inpatient admission). More importantly, Plan N does not cover Part B excess charges.

Part B excess charges occur when a provider does not accept Medicare assignment. Non-participating providers can charge up to 15% above the Medicare-approved amount, and that 15% is entirely the beneficiary’s responsibility under Plan N. Under Plan G, the insurer absorbs it.

The excess-charge state map and why it rewrites the decision

Eight states have enacted laws prohibiting providers from charging more than the Medicare-approved amount: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In these states, excess charges cannot legally exist, which eliminates Plan N’s primary structural disadvantage.

For a Plan N enrollee in one of these eight states, the only out-of-pocket exposure is the office-visit copay and the ER copay. If you see your doctor six times per year, your annual copay exposure is $120. That is well below Plan G’s annual premium premium advantage of $514 at age 65.

Outside these eight states, excess charges are legal and common among specialists. Dermatologists, surgeons, and anesthesiologists are the highest-frequency non-participating providers. A single procedure where the provider charges 15% excess on a $3,000 Medicare-approved fee adds $450 in out-of-pocket cost. Three such visits in a year erases the annual premium saving entirely and tips the balance toward Plan G.

10-year compounded cost projection: healthy vs chronic-condition enrollee

Using 2026 national average premiums from medicaresupplement.com and a 4% annual attained-age increase (a common estimate for attained-age states), the cumulative cost picture over 10 years from age 65:

Healthy enrollee: 6 doctor visits per year, no specialists, no excess charges, two ER visits over 10 years

Plan G cumulative premiums (65-74): approximately $24,100 at 4% annual increase Plan N cumulative premiums (65-74): approximately $17,800 at 4% annual increase Plan N copays over 10 years: 60 office visits at $20 = $1,200 + 2 ER visits at $50 = $100 = $1,300 Plan N total: approximately $19,100 Plan G total: approximately $24,100 Net savings with Plan N: approximately $5,000 over 10 years

Chronic-condition enrollee: 18 doctor visits per year, 4 specialist visits per year outside the 8 protected states, one $10,000 procedure with 15% excess charge at age 72

Plan G cumulative premiums (65-74): approximately $24,100 Plan N cumulative premiums (65-74): approximately $17,800 Plan N copays: 180 office visits at $20 = $3,600 + 4 specialist excess charges per year at average $300 each = $12,000 over 10 years + $1,500 excess on the $10,000 procedure = $17,100 in copays and excess Plan N total: approximately $34,900 Plan G total: approximately $24,100 Net savings with Plan G: approximately $10,800 over 10 years

The break-even in an attained-age state with regular specialist use runs closer to 12-15 office visits per year, or fewer if excess charges apply. The break-even in a community-rated state or issue-age state shifts because the premium gap between G and N stays more stable over time.

The underwriting wall: why switching from N to G later costs more than people expect

During the Medigap Open Enrollment Period (the six months starting the month you turn 65 and enroll in Part B) carriers cannot use medical underwriting. A separate but related risk applies after you make any Medigap choice: medical underwriting after the OEP closes covers how pre-existing conditions affect your options if you try to switch plans later. They must accept you at standard rates regardless of health status. This window closes and does not reopen under federal law.

After OEP, switching from Plan N to Plan G requires medical underwriting in 42 states. The carrier can decline to cover you entirely, or accept you with a higher premium. Common health conditions that trigger underwriting surcharges or denials include: heart disease, COPD, diabetes with complications, cancer history, and recent surgeries. If your health has declined by age 70 or 75 and you decide you want Plan G, you may not be able to get it at any price in most states.

The six states with guaranteed issue protections beyond OEP (Connecticut, Massachusetts, Maine, New York, and Wisconsin, plus partial protections in Missouri) allow switching under limited circumstances. Elsewhere, the decision you make at 65 is effectively permanent. Starting with Plan N to save money in your healthy years carries the risk that you cannot upgrade when your health changes.

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FAQ

Can I switch from Plan N to Plan G during the Medicare Annual Enrollment Period? Medicare’s Annual Enrollment Period (October 15 to December 7) applies to Medicare Advantage and Part D drug plans, not to Medigap supplements. Medigap switching is governed by your state’s rules, not the AEP calendar. In most states, switching Medigap plans requires medical underwriting outside your six-month OEP. Contact your state insurance department to confirm what protections apply in your state before assuming you can switch during AEP.

Does Medigap Plan N cover the Part B deductible? No. Plans sold to new Medicare enrollees after January 1, 2020 are not permitted to cover the Part B deductible under MACRA’s “first-dollar coverage” restrictions. Plan N, like Plan G, requires you to pay the Part B deductible ($283 in 2026) before the policy covers your 20% coinsurance. Plan F covered the Part B deductible but is no longer available to new enrollees.

If my carrier raises my Plan N premium, can I drop to a lower plan level without underwriting? Moving from Plan N to a higher-coverage plan requires underwriting in most states. Moving from Plan N to a lower-coverage plan (such as Plan A) may be possible without underwriting in some states, but lower plans provide less protection, not a solution to the premium increase problem. Rate increases on Plan N are subject to state insurance department review and approval processes, which vary significantly.

How does the pricing model affect the long-term cost of Plan G vs Plan N? Attained-age pricing (the most common model) increases your premium each year as you age. Both Plan G and Plan N premiums increase, but they do not necessarily increase at the same rate. If Plan N’s annual increase rate is similar to Plan G’s, the premium gap between them stays roughly proportional over time. If Plan N increases faster, because its pool is younger and the healthy enrollees who should be in N are leaving for less coverage, the savings narrow over time. Community-rated states (CT, MA, MN, NY) charge everyone in the plan the same rate, so age-driven increases are eliminated.

What happens to Plan N if I move to one of the eight states that ban excess charges? If you relocate from a state where excess charges are legal to one of the eight states that ban them, you benefit from the state law immediately. Non-participating providers in that state cannot charge excess regardless of your plan type. Your Plan N effectively gains the excess-charge protection for free. The reverse is also true: moving from a protected state to a non-protected state exposes you to excess charges that did not exist at your prior address.

Robert paid $7,200 more over 10 years and avoided $380 in excess charges. Linda saved $6,820. That math holds in Ohio. In a non-protected state with regular specialist use, the numbers flip before age 78. The decision is not which plan is better. It is which plan is right for your state, your doctors, and your health trajectory from the moment your OEP opens.