Plan G or Plan N: the whole difference is $20, $50, and excess charges
Medigap letters fix the coverage by law, so the two most popular plans differ in exactly three places. Price those three against your own doctor visits and the choice is arithmetic.
At 65 you choose a road: Original Medicare with a Medigap supplement, or a private Medicare Advantage plan. Then, if you chose Medigap, you choose a letter. For most people it comes down to Plan G or Plan N. Take that choice first, because it is pure arithmetic.
Carol's two quotes
Carol turns 65 in November and got two quotes. Plan G, $121.58 a month. Plan N, $88.00. The gap is $33.58 a month, $403 a year, $4,030 over the decade she expects to keep the plan. Whether Plan N is a $4,030 saving or a false economy depends on three differences and on how many times a year Carol sees a doctor.
The quotes are examples, from a published rate table for a 65-year-old non-smoking woman in Dallas in January 2026, lowest available carrier. Prices differ by state and by age, sometimes by half or double, and yours will differ. The structure of the comparison will not. To get your own, use the Medigap price finder at medicare.gov, or ask your state's free SHIP counselors to run it with you.
What is identical, and the three differences
Medigap plans are lettered, and the letter fixes the coverage by law. A Plan G is the same Plan G at every company; what varies is the price. So the first thing to know is what G and N have in common, which is almost everything. Both pay the Part A hospital deductible, $1,736 in 2026. Both pay the 20 percent of doctor bills that Part B leaves to you. Neither pays the Part B deductible, $283 in 2026, because for anyone who became eligible in 2020 or later no Medigap plan may. That deductible cancels out of the comparison; you pay it either way.
The differences are three.
- Office visits. Plan N can charge up to $20 for some office visits. Plan G charges nothing.
- Emergency room. Plan N can charge up to $50 for an emergency room visit that does not end in admission. Plan G charges nothing.
- Excess charges. Most doctors accept Medicare's approved amount as payment in full. A doctor who does not may bill up to 15 percent more. Plan G pays that extra. Plan N does not. Eight states ban excess charges outright: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.
That is the whole difference. Plan N starts the year $403 ahead, and every visit spends some of that lead.
Three kinds of year
Call a year healthy if Carol sees a doctor twice and never visits the ER: $40 in copays. Call it average at six visits and one ER trip: $170. Call it rough at twelve visits, two ER trips, and one $600 bill from a doctor who does not accept assignment: $940.
| Kind of year | Plan N copays and excess | Premium saved | Plan N ahead by |
|---|---|---|---|
| Healthy (2 visits, no ER) | $40 | $403 | $363 |
| Average (6 visits, 1 ER) | $170 | $403 | $233 |
| Rough (12 visits, 2 ER, $600 excess) | $940 | $403 | minus $537 |
The break-even is $403 of copays and excess charges in a single year. At $20 a visit, that is about twenty visits with no ER trip, or fewer with one. In a state that bans excess charges, a rough year costs $340 and Plan N still finishes $63 ahead.
The realistic decade
Nobody has ten identical years. Say Carol's decade is six healthy years, three average, and one rough. Plan N's copays and excess over the decade come to $240 plus $510 plus $940, or $1,690. The premium saved is $4,030. Plan N finishes $2,340 ahead.
Ten rough years in a row is the case where Plan G wins, by $5,370. It is the case people picture when they choose G. It is also the least likely decade. If you expect many visits a year every year, choose G. Also choose G if you live where excess charges are legal and your doctors do not accept assignment. Otherwise the arithmetic favors N. The difference is real money either way, so run yours.
The other road, briefly
A Medicare Advantage plan replaces Original Medicare, usually bundles drug coverage, and often has a $0 premium beyond Part B. What you trade for that is a network, prior authorization before some care, and copays that add up until you reach the plan's yearly out-of-pocket maximum, as high as $9,250 in 2026 for in-network care. Quietly, you also trade your Medigap window: after the first year, most states let Medigap insurers ask health questions and decline you. If you joined an Advantage plan when you first became eligible at 65 and leave within 12 months, you have a one-time trial right to buy any Medigap plan sold in your state with no health questions. Someone who tries Advantage at 68 has no such right. The workbook puts both roads on one page with your own numbers.
Sources. medicare.gov, "Compare Medigap plan benefits" and "Choosing a Medigap Policy" (publication 02110); CMS fact sheet on 2026 Part A and Part B deductibles; CMS CY2026 Rate Announcement for the Advantage out-of-pocket limit. Premium quotes are illustrative and from a third-party 2026 rate table.
Educational, not advice. Clear Table Press is not affiliated with the Social Security Administration or Medicare. Figures carry their year; confirm current amounts at ssa.gov and medicare.gov.