Medicare

By the Retiree Report Editorial Team · Updated 2026-05-02 · 7 min read

This article is general information, not medical advice. Talk with a licensed clinician before making any decision about your care.

Plan G or Plan N in 2026? The choice is mostly about who absorbs the small bills

Two Medicare Supplement plans dominate the market: Plan G and Plan N. They cover the same hospital bills, the same blood units, the same skilled nursing coinsurance — almost everything Original Medicare leaves on your tab. The real choice in 2026 is whether you’d rather pay a higher monthly premium and forget about it (Plan G), or pay a lower premium and chip in small copays at the doctor’s office (Plan N).

What “standardized” actually means

Federal law makes Medigap simple in one important way: every insurer has to sell the same lettered plans with the exact same benefits. A Plan G from one carrier covers the same things as a Plan G from another. Per Medicare.gov’s plan-comparison chart, both Plan G and Plan N pay your Part A hospital coinsurance plus a 365-day extension after Original Medicare runs out, the Part A inpatient deductible ($1,736 in 2026), the first three pints of blood, hospice coinsurance, skilled nursing facility coinsurance, and 80% of foreign-travel emergency care up to plan limits.

Both plans also pay the 20% Part B coinsurance — the share Original Medicare leaves you owing for doctor visits, lab work, durable medical equipment, and outpatient procedures. That 20% has no annual cap on its own, which is the reason most retirees buy a Medigap policy in the first place.

So if the benefit charts look almost identical, what’s actually different? Three things, and only three: the Part B deductible, Part B excess charges, and Plan N’s office-and-ER copays.

The three differences in plain numbers

Neither plan covers the annual Part B deductible — that’s a federal rule for any Medigap policy sold to people who became eligible for Medicare in 2020 or later. The Centers for Medicare & Medicaid Services set that deductible at $283 for 2026, an increase of $26 over 2025. You pay it once a year before either plan starts splitting the bill with Medicare.

Past the deductible, the differences shake out as:

• Part B excess charges. When a doctor doesn’t accept Medicare assignment, federal law lets them bill up to 15% above the Medicare-approved amount. Plan G picks up that excess; Plan N doesn’t. Eight states ban excess charges entirely under state law, so Plan N’s gap there is moot for those residents.
• Office and ER copays (Plan N only). Plan N charges up to $20 per office visit and up to $50 per emergency-room visit. The ER copay is waived if you’re admitted as an inpatient. The “up to” matters — the copay can never exceed the Part B coinsurance you’d otherwise owe, so a quick lab visit might cost less than $20.

That’s the entire ledger of differences. Hospital coverage, skilled nursing, hospice, foreign travel — identical.

So how much does Plan N really save?

This is where the marketing gets noisy. Premiums vary by state, age, gender, tobacco use, and the carrier’s pricing model — Medicare describes three approaches: community-rated, issue-age-rated, and attained-age-rated. Two 65-year-old women in different ZIP codes can pay double-digit-percentage different premiums for the same lettered plan from the same insurer.

KFF, the health-policy research nonprofit, found the average Plan G monthly premium was $164 in 2023, with a state range from $140 in Washington, D.C., to $236 in New York. Plan N typically runs $30 to $50 lower for the same person in the same market. Late-2025 rate filings showed unusually large hikes for the 2026 plan year, with some states approving 18% to 25% increases on both plans — driven largely by community-rated carriers absorbing higher member utilization.

Here’s the napkin math. If Plan N saves you $40 a month, that’s $480 a year in your pocket — but only as long as you pay less than $480 in copays. At $20 per office visit, that’s 24 visits before Plan N becomes a wash. Most retirees aren’t in a doctor’s office twice a month, so the arithmetic favors Plan N for healthy 65-to-75-year-olds with one or two checkups a year.

The flip happens for people with chronic conditions. If you see a cardiologist monthly, a primary-care doctor every other month, and a specialist quarterly, you can easily rack up 25 visits a year. Add an unwaived ER trip or two and Plan N’s “savings” evaporate. Plan G’s higher fixed premium becomes the cheaper bet because every visit after the Part B deductible is paid in full.

What about high-deductible Plan G?

There’s a third option many shoppers overlook. High-deductible Plan G works like a regular Plan G, but you pay everything out of pocket — including the Part B deductible — until you hit a separate annual deductible set by CMS. For 2026, CMS set that deductible at $2,950, up from $2,870 in 2025. Once you’ve cleared it, the plan covers the same gaps regular Plan G covers.

Premiums on high-deductible Plan G run dramatically lower — often a third or less of regular Plan G — which makes it a serious option for retirees in good health who’d rather self-insure the small stuff and keep real catastrophic protection in the background. The downside is the obvious one: a bad year can mean writing checks for nearly $3,000 before the policy kicks in. It works for people with the cash on hand to absorb that without panic.

The enrollment window doesn’t reopen

Here’s the part most explainers bury, and it matters more than the copay math. Federal law gives you a one-time, six-month Medigap Open Enrollment Period that begins the month you’re 65 and enrolled in Part B. During that window, no insurer can refuse you, charge you more for pre-existing conditions, or use medical underwriting. After it ends, those protections evaporate — outside of a short list of “guaranteed issue” situations like losing employer coverage.

That means switching from Plan N to Plan G three years in because your health changed is not guaranteed. The new insurer can price your application based on your medical history, or decline you entirely. A handful of states have a “birthday rule” or other guaranteed-issue protections that let you switch under specific conditions, but most don’t.

If you’re choosing between Plan G and Plan N at age 65 and you have any reason to think your medical needs will grow, weight that toward Plan G. The premium difference is real, but it’s a smaller risk than being stuck on Plan N when a chronic diagnosis arrives at 72.

How to make the call

Run the actual numbers for your ZIP code. Medicare’s Plan Finder at medicare.gov lists every Medigap policy sold in your area with current premiums; your state insurance department often publishes the same data with rate-history detail. Get quotes from at least three carriers — same plan letter, same benefits, often very different prices.

Then ask yourself three questions, in order. First, how often do I see doctors right now, and is that likely to grow? Second, do my doctors accept Medicare assignment? (You can check on Medicare’s Care Compare tool, or just call.) Third, am I willing to commit to one plan now, knowing I may not be able to switch later? If you’re a low-utilizer in an excess-charge-free state with stable health, Plan N is hard to argue against. If any of those answers tilts the other way, the predictability of Plan G — or even high-deductible Plan G if you have cash on hand — usually wins.

Either way, this isn’t a decision to revisit casually. As you set up the rest of your coverage, our Medicare open enrollment 2026 checklist walks through the dates and forms, and our piece on Medicare Advantage vs Original Medicare for 2026 covers the upstream choice that determines whether you can buy any Medigap plan in the first place.

This is general information, not personalized advice — your state’s rules, your health profile, and your providers’ billing practices all change the answer. Before you sign anything, run quotes from multiple carriers and consider talking to a State Health Insurance Assistance Program (SHIP) counselor for a free, unbiased read on your specific situation.

What to remember

Plan G and Plan N are the same product with one fork: pay more upfront for full predictability, or pay less and accept small copays at the door. Plan N saves money for healthy retirees who don’t visit the doctor often and don’t live where excess charges are allowed. Plan G earns its premium for anyone with regular medical care or anyone who wants zero surprises after the $283 Part B deductible. Whichever you pick, do it during your six-month Medigap open enrollment window — that’s the leverage you don’t get back.