Medicare Supplement Plan G vs. Plan N in 2026: Run the Math Before You Choose

By the time most 63-year-olds start shopping for Medigap coverage, they have read a dozen comparison charts. Every chart says the same thing: Plan G costs more, Plan N costs less, they cover roughly the same things. What the charts almost never show is the actual dollar math of when one beats the other — and one coverage gap in Plan N that can flip the decision depending on where you live and who your doctors are.

What the two plans share

First, clear the noise. Plans G and N are siblings. Both cover:

• Medicare Part A hospital deductible — $1,736 per benefit period in 2026
• Part A coinsurance, including hospital stays beyond 60 days
• Skilled nursing facility coinsurance (days 21–100 of a qualifying stay)
• Part B coinsurance — the standard 20% Medicare leaves to you after the deductible
• Foreign travel emergency — 80% after a $250 deductible, up to a lifetime maximum of $50,000

Both plans also require you to pay the Medicare Part B annual deductible — $283 in 2026 — before coverage kicks in. The only plan that ever covered the Part B deductible was Plan F, which is no longer available to people who became Medicare-eligible after January 1, 2020. If someone is selling you "complete coverage with no deductible," confirm you were eligible before that date.

The three actual differences

Plan G and Plan N diverge on exactly three things:

	Plan G	Plan N
Part B excess charges	Covered	Not covered
Office visit copay	$0	Up to $20
ER copay (if not admitted)	$0	Up to $50

That is the entire list. Three line items. The first one is the most consequential.

Excess charges are what a physician can bill you above Medicare's approved rate. Doctors who do not accept Medicare assignment — meaning they have not agreed to Medicare's fee schedule — can charge up to 15% above the approved amount. On a $600 procedure, that is up to $90 extra. On a $6,000 surgery, it is up to $900. With Plan N, you absorb that overage directly. With Plan G, the plan pays it.

The good news: the vast majority of providers accept Medicare assignment. CMS data puts the non-participating rate nationally well under 5%. The catch is that the non-participating rate is not evenly distributed. In some high-cost metro markets, certain specialists — cardiologists, orthopedists, oncologists at academic medical centers — operate outside Medicare's fee schedule more often. If your current doctors accept assignment and you plan to stay in their network, Plan N's excess-charge exposure is largely theoretical. If you live in a high-cost market or see specialists whose assignment status you have not verified, Plan G's extra premium buys real insurance, not just peace of mind.

One practical step: call each provider's billing office and ask, "Do you accept Medicare assignment?" Medicare's online physician finder also lets you check. This five-minute check can decide the Plan G vs. N question more precisely than any comparison article.

The breakeven math

In 2026, Plan G premiums for a 65-year-old non-smoker typically run $120–$175/month, varying by state, insurer, and the rating method the carrier uses (community-rated versus issue-age versus attained-age). Plan N for the same person runs roughly $60–$80 less per month. A $60/month difference is a reasonable working figure — but pull actual quotes for your zip code, because the spread can be anywhere from $35 to $100 depending on the market.

At $60/month, the annual premium savings from Plan N is $720. To break even, your extra out-of-pocket from copays and excess charges needs to exceed $720 in a given year.

Consider two hypothetical retirees:

Margaret, 65, healthy: Sees her primary care physician eight times a year, had one urgent-care visit billed as emergency (not admitted). All providers accept assignment.

• Plan N premium savings vs. Plan G: $720/year
• Office copays (8 × $20): $160
• ER copay (1 × $50): $50
• Net savings with Plan N: $510 per year

Gerald, 68, manages Type 2 diabetes: Sees his PCP plus an endocrinologist and a podiatrist regularly. His endocrinologist does not accept Medicare assignment.

• Plan N premium savings vs. Plan G: $720/year
• Office copays (14 visits × $20): $280
• Excess charges on three specialist visits (estimated at $150 each): $450
• Net savings with Plan N: $720 − $730 = $10 behind on a typical year — and worse in any year with a procedure

The math generally favors Plan N for healthy seniors with modest healthcare use and assignment-accepting providers, and tilts toward Plan G as visit frequency and specialist complexity increases. A useful rule of thumb: if you average more than 15 covered physician visits per year, or if any regular provider does not accept assignment, run the numbers explicitly before assuming Plan N wins.

Rate increases over time

Medigap premiums rise — sometimes materially. Plan G's higher initial premium also gives future increases a larger base to compound from. Plan N's lower base grows from a smaller starting point, which matters over a 15–20 year horizon if you enroll at 65.

That said, rate increases on both plans depend primarily on the insurer's claims experience, not just the plan type. Insurers with larger, more stable enrollee pools tend to be more rate-predictable. Before committing, check a carrier's rate increase history — some state insurance departments publish this data by insurer. Carriers that have raised premiums aggressively in the past two years are worth a harder look.

High-deductible Plan G: the third option

There is a variant worth knowing: High-Deductible Plan G (HDG). It carries the same coverage as standard Plan G — including excess-charge protection — but you pay a CMS-set annual deductible before the Medigap coverage kicks in. Monthly premiums are often in the $40–$60 range, well below either standard Plan G or Plan N.

HDG is most appropriate for retirees with strong emergency savings who can absorb a bad year out of pocket. If that describes you and you want Plan G's excess-charge protection at near-Plan-N prices, get an HDG quote alongside the standard plans. The coverage differences between HDG and standard Plan G are meaningful in a costly year, but over a decade the cumulative premium savings can easily outpace the deductible cost in typical years.

The enrollment window that shapes everything

The best time to buy Medigap is your six-month Medigap Open Enrollment Period, which begins on the first day of the month you are both 65 (or older) and enrolled in Part B. During that window, insurers must sell you any plan at their standard rate regardless of health history. Miss it, and most states allow medical underwriting — meaning a prior cancer diagnosis, heart disease, or diabetes can result in denial or significantly higher premiums.

If you are managing the transition from early retirement to Medicare, the timing of Part B enrollment — and the IRMAA surcharges that follow from income two years prior — interact in ways that catch people off guard. The when can I retire calculator includes a healthcare cost module that models the full arc from early-retirement ACA coverage through Medicare enrollment and IRMAA exposure.

For those planning a retirement at 65 specifically, the retire at 65 calculator lets you project the first years of Medicare-covered retirement, including Medigap premiums as a persistent expense line. And if you are still in the years between leaving work and Medicare eligibility, the healthcare before Medicare guide covers ACA bridge strategies, COBRA timelines, and subsidy cliffs to navigate.

The bigger picture — whether your portfolio can support the retirement you are planning, with healthcare costs built in — is exactly what Granary models: taxes, RMDs, Social Security timing, and healthcare costs projected together against your actual accounts.

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This post is planning education, not tax or insurance advice. Medigap premiums, coverage rules, and plan availability vary by state; consult a licensed independent Medicare broker or your state's free SHIP counselor for quotes specific to your situation.