Plan G or Plan N: the two things that actually separate them

Every week someone arrives having been told that Plan G is the good one and Plan N is the cheap one. That is not wrong exactly, but it is the kind of half-explanation that leads people to overpay for years or, occasionally, to be caught out by a bill they were told could not happen.

Both are federally standardised. A Plan G pays identically whoever issues it, and so does a Plan N. So this is not a comparison of products — it is a comparison of two specific gaps in an otherwise identical policy.

What they share

Plan G and Plan N both cover, in full:

• Part A hospital coinsurance, plus 365 extra hospital days after Medicare’s own benefits run out
• The Part A deductible, which is charged per benefit period rather than annually
• Skilled nursing facility coinsurance for days 21 to 100
• The first three pints of blood in a year
• Part A hospice coinsurance for respite care and outpatient drugs

Both also pay 80% of emergency care abroad in the first 60 days of a trip, up to a $50,000 lifetime maximum. Neither covers the annual Part B deductible — no policy sold to anyone newly eligible since 1 January 2020 may.

Difference one: office and emergency room copays

Plan G covers your Part B coinsurance in full. After the Part B deductible is met, a Plan G holder generally sees no further bill for a Medicare-approved service.

Plan N covers the same coinsurance, but leaves you a copay of up to $20 for some office visits and up to $50 for an emergency room visit that does not result in admission. Those caps are set in the standardisation, so they cannot creep upward with your premium.

The arithmetic is straightforward. If you see a doctor four times a year, Plan N costs you up to $80 in copays. If the Plan N premium is more than $80 a year cheaper, you are ahead. For most people in most states it is considerably more than that.

Difference two: Part B excess charges

This is the one people skip, and it is the one that varies by geography.

A provider who accepts Medicare assignment agrees to take the Medicare-approved amount as full payment. A provider who does not — a non-participating provider — may bill you up to 15% above that amount. That extra 15% is a Part B excess charge.

Plan G covers excess charges. Plan N does not.

How much this matters depends entirely on where you live and who you see:

• A handful of states, including New York, Pennsylvania, Ohio, Connecticut, Rhode Island, Massachusetts, Minnesota and Vermont, restrict or prohibit excess charges outright. In those places the risk is close to zero.
• Nationally, the overwhelming majority of providers accept assignment. The exposure is real but small.
• If you see a specialist who does not accept assignment — and some surgical and psychiatric practices do not — the exposure stops being theoretical.

So which one

Plan N tends to be the better bet if you use care lightly, live somewhere excess charges are restricted or rare, and would rather hold the monthly premium down.

Plan G tends to be the better bet if you want to be able to stop thinking about it, if you see specialists regularly, or if the difference in premium is small enough that certainty is worth buying.

Neither is a lesser version of the other. They are two different bets, and the only bad outcome is placing one without knowing what you bet on.

One thing to settle first

Whichever letter you choose, choose it during your Medigap Open Enrollment Period if you can — the six months that begin the first month you are both 65 or older and enrolled in Part B. Inside that window an insurer must sell you any policy it offers, at its best rate, regardless of your health. Outside it, in most states, it may ask about your health and it may decline you.

That asymmetry does more to determine what your options look like at 72 than the choice between G and N ever will.