Medicare Plan G vs Plan N: The Real Cost Difference
When new Medicare enrollees ask "Plan G or Plan N?", the question is usually framed as a coverage comparison. It's actually a usage question. Both plans cover the same major medical services. The difference is whether you pay flat $0 after the Part B deductible (Plan G) or up to $20 per office visit and $50 per ER visit (Plan N). For some retirees, the second option saves $400/year. For others, it costs $300/year.
What's the same
Both Plan G and Plan N cover, in full:
- Part A hospital deductible ($1,676 in 2026)
- Part A inpatient hospital coinsurance, up to 365 additional days beyond Medicare's coverage
- Part A skilled nursing facility coinsurance (days 21–100)
- Part A hospice care coinsurance
- First three pints of blood
- Foreign travel emergency at 80% (up to $50,000 lifetime)
For hospitalizations, skilled nursing stays, and hospice care, the two plans are functionally identical. The differences are concentrated in the Part B (outpatient) experience.
What's different
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A coinsurance & hospital costs (up to 365 extra days) | 100% | 100% |
| Part B coinsurance / copayment | 100% | 100%* |
| Blood (first 3 pints) | 100% | 100% |
| Part A hospice care coinsurance | 100% | 100% |
| Skilled nursing facility coinsurance | 100% | 100% |
| Part A deductible | 100% | 100% |
| Part B deductible | ✕ Not covered | ✕ Not covered |
| Part B excess charges | 100% | ✕ Not covered |
| Foreign travel emergency (up to plan limit) | 80% | 80% |
* Plan N requires up to a $20 copay for some office visits and up to $50 for ER visits that don't result in admission.
The three differences:
- Part B coinsurance. Plan G covers 100%. Plan N covers 100% but with up-to-$20 office visit copays and up-to-$50 ER copays (waived if admitted).
- Part B excess charges. Plan G covers them. Plan N doesn't.
- Premium. Plan G typically runs $30–$50/month higher than Plan N for the same person in the same state.
The annual cost math
Run the numbers with realistic estimates:
Scenario 1: Healthy 67-year-old, infrequent medical use
- Annual office visits: 4 × $20 = $80 (Plan N copays)
- ER visits: 0
- Excess charges: 0 (uses Medicare-participating providers)
- Plan G annual premium: $1,680 ($140/month)
- Plan N annual premium: $1,260 ($105/month)
- Plan G total cost: $1,680 + $0 = $1,680
- Plan N total cost: $1,260 + $80 = $1,340
- Plan N saves: $340/year
Scenario 2: Active 73-year-old with multiple chronic conditions
- Annual office visits: 18 × $20 = $360 (Plan N copays)
- ER visits not resulting in admission: 1 × $50 = $50
- Excess charges: ~$60
- Plan G annual premium: $1,920 ($160/month)
- Plan N annual premium: $1,440 ($120/month)
- Plan G total cost: $1,920 + $0 = $1,920
- Plan N total cost: $1,440 + $360 + $50 + $60 = $1,910
- Roughly even — Plan N saves: $10/year
Scenario 3: Chronically ill 79-year-old
- Annual office visits: 28 × $20 = $560
- ER visits not admitted: 2 × $50 = $100
- Excess charges: $120
- Plan G annual premium: $2,400 ($200/month)
- Plan N annual premium: $1,860 ($155/month)
- Plan G total cost: $2,400 + $0 = $2,400
- Plan N total cost: $1,860 + $560 + $100 + $120 = $2,640
- Plan G saves: $240/year
The pattern: Plan N wins for low-utilization users; Plan G wins for high-utilization users. The crossover point is somewhere around 12–18 office visits per year, depending on premium spread in your state and presence of excess charges.
The state factor
State pricing matters. In high-cost states like New York, Connecticut, and Massachusetts, both Plan G and Plan N premiums are substantially higher (community-rated pricing in some), but the dollar spread between them is also larger — meaning the premium savings of Plan N is larger in absolute terms. In lower-cost states like Iowa, North Dakota, and Idaho, both plans run lower; the spread between them is smaller.
Excess charges are state-specific too. Eight states prohibit them by law: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont. In those states, Plan N's non-coverage of excess charges is functionally moot.
For state-specific premium ranges, see our Plan G cost lookup tool — Plan N premiums typically run 20–30% lower in the same markets.
The age factor
Premium spreads typically widen with age in attained-age states. At 65, Plan G might be $40/month more than Plan N. At 80, the same person on the same carriers might see a $70/month spread because the Plan G premium grew faster.
If you're 65 and choosing between G and N today, project forward: would you expect to remain on the same plan until 85? If so, model the premium savings over 20 years rather than just one. The total premium savings on Plan N over a long retirement can run into 5 figures for healthy users.
The risk-tolerance question
Beyond the math, there's a behavioral question. Plan G means you essentially never see medical bills (after the Part B deductible). Plan N means you do — small ones, predictably, but you do. Some people find it psychologically easier to pay one steady premium and have $0 cost at the point of service. Others don't mind small per-visit copays.
If you would feel anxious about a doctor's office collecting $20 from you each visit, Plan G removes that. If $20 here and there doesn't bother you, Plan N gives you the premium savings.
Which to start with
Practical guidance for new enrollees:
- If you're healthy and cost-conscious: Plan N. Take the premium savings; the per-visit costs are manageable and the long-run premium savings can be substantial.
- If you have any chronic conditions or expect frequent specialist use: Plan G. Predictability is worth the extra premium.
- If you're not sure: Plan G. The default for new enrollees. You can always switch to Plan N later if your state's rules allow it without underwriting; switching the other direction can be harder.
- If you're in a state with continuous open enrollment: Either is fine. You have flexibility to switch later.