Medicare Plan N: What It Costs & Covers in 2026
Plan N is the Medigap option people end up buying when their licensed agent says, "OK, but if you really want to lower the premium, here's what we can do." It's not the most popular Medigap plan. It is, for a meaningful slice of the market, the most economically sensible one.
What Plan N covers
Plan N is a standardized Medigap policy. Like all Medigap plans, it pays for Original Medicare's cost-sharing — but Plan N has three specific gaps that Plan G doesn't:
- Up to $20 per office visit. When you see a doctor for an office visit (not preventive care), you pay up to $20 of the Medicare coinsurance. Plan N covers the rest.
- Up to $50 per ER visit, waived if admitted. If you go to the ER and are sent home, you pay up to $50. If the visit results in an inpatient admission, the $50 is waived.
- No coverage for Part B excess charges. If a non-participating doctor charges more than the Medicare-approved rate (up to 15% more), you're responsible for that overage. Plan G covers it.
For most beneficiaries who use 4–8 office visits a year and rarely visit the ER, Plan N's gaps cost roughly $100–$200/year in additional out-of-pocket spending. The premium savings of $360–$720/year over Plan G typically more than offset that.
| 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.
Premium comparison: real 2026 numbers
The reason Plan N exists as a viable choice comes down to month-by-month premium savings. Indicative 2026 monthly premiums for a 65-year-old non-tobacco-using woman in a typical state market:
- Plan G: $135–$160/month
- Plan N: $95–$120/month
- Difference: $30–$50/month, or $360–$600/year
For a healthy retiree who visits the doctor a few times a year, Plan N typically nets out as the cheaper choice — sometimes by $200–$400/year. For frequent medical users, the per-visit copays add up and Plan G regains the cost advantage.
The Part B excess charge consideration
Part B excess charges are easy to underestimate or overestimate. The reality:
- The vast majority of doctors accept Medicare assignment, meaning they accept the Medicare-approved rate as full payment. Excess charges don't apply.
- Non-participating doctors exist mainly in concierge practices and some specialty areas (psychiatry, certain surgical specialties).
- Eight states explicitly prohibit excess charges by law: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont. In those states, Plan N's non-coverage of excess charges is irrelevant.
- If you live elsewhere and have non-participating providers, ask whether they accept Medicare assignment before scheduling. Most will.
For most beneficiaries, the Part B excess charge gap in Plan N is theoretical rather than financially meaningful.
Who Plan N is right for
- Healthy retirees with low expected medical use. If you visit doctors a few times a year and rarely go to the ER, the per-visit copays don't add up to much. Premium savings are real.
- Beneficiaries in states without Part B excess charges. The Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont group can take the premium savings without the excess-charge concern.
- Cost-sensitive enrollees who don't want Medicare Advantage's network restrictions. Plan N preserves Original Medicare's nationwide acceptance — any doctor who takes Medicare. Lower premium than Plan G, less administrative friction than MA.
- Long-term Medigap holders considering downgrading. If you've had Plan F or Plan G for years and want to lower premiums in retirement, Plan N is often the natural step down — assuming you can pass underwriting in your state.
Who Plan N isn't right for
- People with chronic conditions requiring frequent specialist visits. If you see specialists 12+ times a year, the $20 office copays accumulate to $240+/year, eroding the premium savings.
- People who anticipate frequent ER use. ER copays of $50 each visit add up if you have a condition causing recurrent ER trips.
- People living in rural areas with limited Medicare-participating providers. If many of your local providers are non-participating (charging excess charges), Plan N's gap there matters more.
- People who strongly prefer no out-of-pocket exposure at all. Plan N exposes you to small per-visit costs. Plan G generally doesn't (after the deductible).
The Plan N vs. Plan G calculation, plain
Pull out a piece of paper. Estimate your annual:
- Office visits: ____ × $20 = ____ (Plan N additional cost)
- ER visits not resulting in admission: ____ × $50 = ____
Add those two numbers. Compare to the annual premium savings (Plan G monthly minus Plan N monthly × 12).
If premium savings exceed your projected per-visit costs, Plan N saves you money. If not, Plan G saves you money. For most retirees with average medical utilization, Plan N wins by $100–$300/year. For heavy medical users, Plan G wins by $200–$500/year.
The enrollment window for Plan N is the same as for Plan G
Your Medigap Open Enrollment Period — six months starting from your Part B effective date at age 65 or later — is the only window during which Medigap carriers cannot underwrite. During open enrollment, you can buy any Medigap plan including Plan N regardless of health status, and the premium is based only on age, gender, tobacco use, and ZIP code.
After open enrollment closes, most states allow carriers to medically underwrite Plan N applications — which can mean higher premiums or denial of coverage based on health history. A handful of states have continuous open enrollment or guaranteed-issue rules; check your state's specific rules with your agent.
How household discounts affect Plan N pricing
Many Plan N carriers offer household discounts of 5–12% when both spouses or partners enroll. Some carriers extend the discount even if only one member is on Medicare — the partner just needs to be a co-resident. Always ask about household discount eligibility; the savings can be meaningful.
Pairing Plan N with Part D
Like all Medigap plans, Plan N doesn't include prescription drug coverage. You buy a separate Part D plan, usually for $20–$50/month, to handle medications. The drug plan choice is independent of your Medigap carrier.
Switching between Plan G and Plan N over time
It's not unusual for Medigap holders to switch plans as their medical needs change. Common patterns:
- Start on Plan G during the initial open enrollment, when comprehensive coverage is straightforward to obtain. Stay on Plan G as long as health is uncertain.
- If health is good and medical use is low after several years, consider switching to Plan N to reduce premiums — but only if your state allows the switch without underwriting, or you're confident you can pass underwriting.
- Switch back to Plan G later if medical needs increase. Underwriting again applies in most states.
Some states have specific provisions making Medigap switches easier — California's Birthday Rule, Missouri's Anniversary Rule, Oregon's Birthday Rule, Idaho's annual switching window. If you're in one of these states, mid-life switches between Plan G and Plan N are practically achievable.